Inbar Rotem, Shoenfeld Yehuda
Department of Medicine B and Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel.
Isr Med Assoc J. 2009 Jan;11(1):50-3.
Cardiac troponins are released from myocytes following myocardial damage and loss of membrane integrity. Their significance when diagnosing acute myocardial infarction is immense, e.g., their high sensitivity and specificity for myocardial tissue, the prognostic information they bear, and their role in risk stratification and therapeutic decisions. However, one cannot fully and blindly rely on cTn testing in diagnosing acute MI since many other conditions are associated with elevation of troponin. A review of the literature demonstrates a myriad of such examples including non-thrombotic cardiac injury, systemic diseases and laboratory interferences. Failure to acknowledge the differential diagnosis of elevated troponin may lead to over-diagnosis of MI and, accordingly, misdiagnosis of the real cause. It is of utmost importance that all physicians who measure troponin recognize the possibility of falsely diagnosing Ml and are familiar with the main alternative causes for cardiac troponin elevation.
心肌损伤和细胞膜完整性丧失后，心肌肌钙蛋白从心肌细胞中释放出来。它们在诊断急性心肌梗死时的意义重大，例如，它们对心肌组织具有高敏感性和特异性，携带预后信息，以及在风险分层和治疗决策中发挥作用。然而，在诊断急性心肌梗死时，不能完全盲目地依赖肌钙蛋白检测，因为许多其他情况也与肌钙蛋白升高有关。文献综述显示了无数这样的例子，包括非血栓性心脏损伤、全身性疾病和实验室干扰。未能认识到肌钙蛋白升高的鉴别诊断可能导致心肌梗死的过度诊断，进而误诊真正的病因。至关重要的是，所有检测肌钙蛋白的医生都应认识到误诊心肌梗死的可能性，并熟悉导致心肌肌钙蛋白升高的主要其他原因。
