Lavoinne A, Cauliez B
Laboratoire de biochimie médicale, hôpital Charles-Nicolle, Rouen, France.
Rev Med Interne. 2004 Feb;25(2):115-23. doi: 10.1016/s0248-8663(03)00218-2.
Cardiac troponin I and troponin T have replaced creatine kinase MB (CK-MB) for the diagnosis of cardiomyocyte necrosis. Cardiac specificity of these new markers leads to a change in our practice.
Following necrosis, intracellular proteins are released into blood. This easy concept overlaps a biological complexity since troponins are released as complexes leading to various cut-off values depending on the assay used, as least for cardiac troponin I. The increase in both specificity and analytical sensitivity of these markers reached to propose a new definition of myocardial infarction. The diagnosis of acute coronary syndrome is a clinical based diagnosis, the use of troponin contributing to their classification. Finally, pathological processes leading to cardiac injury may induce an increase in the cardiac troponin level.
Troponin standardization is a challenge for the near future leading to better follow-up of patients and comparison between cohorts.
心肌肌钙蛋白I和肌钙蛋白T已取代肌酸激酶同工酶MB(CK-MB)用于诊断心肌细胞坏死。这些新标志物的心脏特异性导致了我们诊疗实践的改变。
坏死发生后,细胞内蛋白质释放入血。这一简单概念掩盖了生物学复杂性,因为肌钙蛋白以复合物形式释放,根据所使用的检测方法会导致不同的临界值,至少对于心肌肌钙蛋白I是这样。这些标志物特异性和分析灵敏度的提高促使人们提出了心肌梗死的新定义。急性冠状动脉综合征的诊断是基于临床的诊断,肌钙蛋白的检测有助于对其进行分类。最后,导致心脏损伤的病理过程可能会使心肌肌钙蛋白水平升高。
肌钙蛋白标准化是近期的一项挑战,有望实现对患者更好的随访以及不同队列之间的比较。