Tsai Shih-Hung, Chu Shi-Jye, Hsu Ching-Wang, Cheng Shu-Meng, Yang Shih-Ping
Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Am J Emerg Med. 2008 Mar;26(3):331-41. doi: 10.1016/j.ajem.2007.05.031.
Cardiac troponins (cTn) are frequently assessed in patients presenting at the emergency department (ED) with chest pain and various diseases in which myocardial injury may be involved. Cardiac troponins are no longer only used for diagnostic investigations in acute coronary syndrome but may also provide valuable information regarding screening, prognosis, and risk stratification and help to guide therapeutic planning and ED dispositioning of patients with many different types of critical illnesses. Elevation of cTn is usually related to myocardial damage but is not synonymous with acute coronary syndrome. Other etiologies should be considered in the differential diagnosis of a patient presenting with atypical symptoms and elevated cTn, as accurate diagnosis will affect both the initial treatment as well as the initial triage. A thorough knowledge of how to interpret the implications of elevated cTn will allow ED physicians to expand their list of differential diagnoses, facilitate risk stratification and ED disposition, and avoid potential iatrogenic complications resulting from inappropriate interventional therapies.
对于因胸痛到急诊科（ED）就诊的患者以及可能涉及心肌损伤的各种疾病患者，通常会检测心肌肌钙蛋白（cTn）。心肌肌钙蛋白不再仅用于急性冠状动脉综合征的诊断检查，还可为筛查、预后和风险分层提供有价值的信息，并有助于指导多种不同类型危重病患者的治疗规划和急诊科处置。cTn升高通常与心肌损伤有关，但并不等同于急性冠状动脉综合征。对于出现非典型症状且cTn升高的患者进行鉴别诊断时，应考虑其他病因，因为准确的诊断会影响初始治疗以及初始分诊。深入了解如何解读cTn升高的意义，将使急诊科医生能够扩展其鉴别诊断清单，促进风险分层和急诊科处置，并避免因不适当的介入治疗导致的潜在医源性并发症。
