Berroëta C, Provenchère S, Mongredien A, Lasocki S, Benessiano J, Dehoux M, Philip I
Département d'anesthésie-réanimation, hôpital Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, 48 rue Henri-Huchard, 75018 Paris, France.
Ann Fr Anesth Reanim. 2006 Oct;25(10):1053-63. doi: 10.1016/j.annfar.2005.05.017. Epub 2005 Jul 12.
Measurement of cardiac troponin I or T in serum (highly specific for the myocardium) have replaced classical markers, such as creatine kinase MB. Cardiac troponins are preferred markers because of their high specificity and sensitivity. This had led to modifications of the original World Health Organization criteria for acute myocardial infarction. Furthermore, the place of the troponins as superior markers of subsequent cardiac risk in acute coronary syndrome has now become firmly established, for both diagnostic and risk stratification purposes. The use of C-reactive protein and/or other inflammatory biomarkers may add independent information in this context. After non cardiac surgery, the total cardiospecificity of cardiac troponins explains why other biomarkers of necrosis should no longer be used. Recent studies suggest that any elevation of troponin in the postoperative period is indicative of increased risk of long-term cardiac complications. This prognostic value has been previously demonstrated in other clinical settings such as invasive coronary intervention (surgical myocardial revascularization and percutaneous coronary intervention) and after heart valve surgery. Increases of troponin indicate cardiac damage, whatever the mechanism (ischemic or not). Other causes of cardiac injury include: pulmonary embolism, myocarditis, pericarditis, congestive heart failure, septic shock, myocardial contusion. In most cases, elevation of troponins has been shown to be associated with a bad outcome.
血清中心肌肌钙蛋白I或T的检测（对心肌具有高度特异性）已取代了传统标志物，如肌酸激酶MB。由于其高特异性和敏感性，心肌肌钙蛋白是更为优选的标志物。这导致了世界卫生组织急性心肌梗死原有标准的修订。此外，无论是出于诊断还是风险分层目的，肌钙蛋白作为急性冠状动脉综合征后续心脏风险的 superior标志物的地位现已牢固确立。在这种情况下，使用C反应蛋白和/或其他炎症生物标志物可能会提供独立信息。非心脏手术后，心肌肌钙蛋白的总体心脏特异性解释了为何不应再使用其他坏死生物标志物。最近的研究表明，术后肌钙蛋白的任何升高都表明长期心脏并发症风险增加。这种预后价值先前已在其他临床环境中得到证实，如侵入性冠状动脉介入治疗（外科心肌血运重建和经皮冠状动脉介入治疗）以及心脏瓣膜手术后。肌钙蛋白升高表明存在心脏损伤，无论其机制如何（是否缺血）。心脏损伤的其他原因包括：肺栓塞、心肌炎、心包炎、充血性心力衰竭、感染性休克、心肌挫伤。在大多数情况下，肌钙蛋白升高已被证明与不良结局相关。
