Collinson Paul O, Gaze David C
Departments of Chemical Pathology, Cardiac Research and Cardiology, St George's Hospital and Medical School, Blackshaw Road, London SW17 0QT, United Kingdom.
Heart Lung Circ. 2007;16 Suppl 3:S71-82. doi: 10.1016/j.hlc.2007.05.006. Epub 2007 Jul 6.
Acute coronary syndromes (ACS) are due to the rupture or erosion of atheromatous plaques. This produces, depending on plaque size, vascular anatomy and degree of collateral circulation, progressive tissue ischaemia which may progress to cardiomyocyte necrosis and subsequent cardiac remodelling. Cardiac biomarkers can be used for diagnosis and assessment of all of these stages. Markers to detect myocardial ischaemia at the pre-infarction stage are potentially the most interesting but also the most challenging. An ischaemia marker offers the opportunity to intervene to prevent progression to infarction. The challenges with potential ischaemia markers are specificity and the diagnostic reference standard for assessment. To date, only one, ischaemia modified albumin, has reached the point where clinical studies can be performed. The measurement of the cardiac troponins, cardiac troponin T and cardiac troponin I, has become the diagnostic standard as the biomarker of myocardial necrosis. The sensitive nature of troponin measurement has also revealed that myocardial necrosis is also found in a range of other clinical situations. This illustrates the need to use all clinical information for diagnosis of acute myocardial infarction. The measurement of B type natriuretic peptides can be shown to be diagnostic and prognostic for both acute ACS and detecting the sequelae of post infarction myocardial insufficiency. The role of the B type natriuretic peptides in detection of cardiac failure, acute and chronic, is well defined. Their role in ACS remains the subject of further studies.
急性冠状动脉综合征（ACS）是由动脉粥样硬化斑块破裂或糜烂引起的。根据斑块大小、血管解剖结构和侧支循环程度，这会导致进行性组织缺血，进而可能发展为心肌细胞坏死及随后的心脏重塑。心脏生物标志物可用于诊断和评估所有这些阶段。在梗死前期检测心肌缺血的标志物可能是最令人感兴趣的，但也是最具挑战性的。一种缺血标志物提供了进行干预以预防进展为梗死的机会。潜在缺血标志物面临的挑战是特异性以及用于评估的诊断参考标准。迄今为止，只有一种，即缺血修饰白蛋白，已达到可进行临床研究的阶段。心肌肌钙蛋白（心肌肌钙蛋白T和心肌肌钙蛋白I）的测量已成为作为心肌坏死生物标志物的诊断标准。肌钙蛋白测量的敏感性还表明，在一系列其他临床情况下也发现了心肌坏死。这说明了需要利用所有临床信息来诊断急性心肌梗死。B型利钠肽的测量已被证明对急性ACS以及检测梗死后心肌功能不全的后遗症具有诊断和预后价值。B型利钠肽在检测急慢性心力衰竭中的作用已得到明确界定。它们在ACS中的作用仍是进一步研究的主题。
