Ikeda Jun, Zenimoto Mikio, Kita Masami, Mori Mayumi
Department of Clinical Laboratory, Tokyo Metropolitan Geriatric Medical Center, Itabashi-ku, Tokyo, 173-0015.
Rinsho Byori. 2002 Oct;50(10):982-6.
Cardiac troponin(cTn) is a sensitive marker for acute myocardial infarction(AMI). However, some cases of renal failure have been reported to show false positive results for cardiac troponin T(cTnT). Recently, it has been reported that heart-type fatty acid-binding protein(H-FABP) is a sensitive marker for AMI in the early phase. We evaluated the usefulness of cardiac troponin I(cTNI) using serum samples from patients(age 57-96) confirmed to have AMI with chest pain(n = 48), unstable angina pectoris(n = 11), cardiac failure(n = 5), others with high creatine phosphokinase(CK) activity(n = 81) and renal failure(n = 28), by comparing among cTnT(qualitative and quantitative), H-FABP, CK and creatine phosphokinase isoenzyme MB(CK-MB) activity. The diagnostic validity of cTn was assessed by receiver operating characteristic(ROC) curve analysis. The cut off value for AMI of cTnI was 0.8 ng/ml, cTnT was 0.16 ng/ml and H-FABP was 19.0 ng/ml. The overall diagnostic sensitivity of cTnI was 83.1%, and 84.8% for cTnT (quantitative), 72.3% for cTnT(qualitative), 64.8% for H-FABP, 81.8% for CK and 59.3% for CK-MB. The overall diagnostic specificity of cTnI was 90.9%, and 81.3% for cTnT(quantitative), 60.5% for cTnT (qualitative), 53.2% for H-FABP, 52.9% for CK and 87.7% for CK-MB. The overall diagnostic efficiency of cTnI was 86.5%, and 82.7% for cTnT(quantitative), 63.6% for cTnT(qualitative), 59.8% for H-FABP, 69.0% for CK and 71.9% for CK-MB. False positive results for cTnI were found in a few cases with renal failure. cTnT(qualitative) showed false positive results in 22/28 with serum creatinine over 2.1 mg/dl due to renal failure. In conclusion, cTnI detection is considered a useful and sufficiently sensitive marker for AMI.
心肌肌钙蛋白（cTn）是急性心肌梗死（AMI）的敏感标志物。然而，据报道，一些肾衰竭病例的心肌肌钙蛋白T（cTnT）显示出假阳性结果。最近，有报道称心脏型脂肪酸结合蛋白（H-FABP）是AMI早期的敏感标志物。我们使用来自确诊患有胸痛的AMI患者（年龄57 - 96岁，n = 48）、不稳定型心绞痛患者（n = 11）、心力衰竭患者（n = 5）、其他肌酸磷酸激酶（CK）活性高的患者（n = 81）和肾衰竭患者（n = 28）的血清样本，通过比较cTnT（定性和定量）、H-FABP、CK和肌酸磷酸激酶同工酶MB（CK-MB）活性，评估了心肌肌钙蛋白I（cTNI）的实用性。通过受试者操作特征（ROC）曲线分析评估cTn的诊断有效性。cTNI诊断AMI的临界值为0.8 ng/ml，cTnT为0.16 ng/ml，H-FABP为19.0 ng/ml。cTNI的总体诊断敏感性为83.1%，cTnT（定量）为84.8%，cTnT（定性）为72.3%，H-FABP为64.8%，CK为81.8%，CK-MB为59.3%。cTNI的总体诊断特异性为90.9%，cTnT（定量）为81.3%，cTnT（定性）为60.5%，H-FABP为53.2%，CK为52.9%，CK-MB为87.7%。cTNI在少数肾衰竭病例中出现假阳性结果。cTnT（定性）在28例因肾衰竭血清肌酐超过2.1 mg/dl的患者中有22例显示假阳性结果。总之，cTNI检测被认为是诊断AMI的一种有用且足够敏感的标志物。
