Emergency Department, 2nd Medical School, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2011 Feb;15(2):229-40.
The use of biomarkers has been demonstrated useful in many acute diseases both for diagnosis, prognosis and risk stratification.
The purpose of this review is to analyze several biomarkers of potential use in patients referring to Emergency Department with acute dyspnea.
The role of natriuretic peptides has a proven utility in the diagnosis, risk stratification, patient management and prediction of outcome in acute and chronic heart failure (HF). New immunoassays are available for the detection of mid-region prohormones in patients with acute dyspnea such as Mid-region pro-adrenomedullin (MR-proADM) and Mid-region pro-atrial natriuretic peptide (MR-proANP). Also procalcitonin, copeptin and D-dimer, which are markers of inflammation, bacterial infections and sepsis, seem to be useful in the differential diagnosis of dyspnea. Conventional and high-sensitivity troponins are fundamental, not only in the diagnosis of acute coronary syndromes, but also as indicators of mortality in patients with acute decompensated heart failure.
Further studies with randomized controlled clinical trials will be needed to prove the theoretical clinical advantages offered by a shortness of breath biomarkers in terms of diagnostic, prognostic, cost effective work-up and management of patients with acute dyspnea.
A multimarker pannel approach performed by rapid and accurate assays could be useful for emergency physicians to promptly identify different causes of dyspnea thus managing to improve diagnosis, treatment and risk stratification.
生物标志物在许多急性疾病中的应用已被证明是有用的，无论是在诊断、预后还是风险分层方面。
本综述的目的是分析几种在因急性呼吸困难就诊于急诊科的患者中具有潜在应用价值的生物标志物。
利钠肽在急性和慢性心力衰竭（HF）的诊断、风险分层、患者管理和预后预测方面具有已证实的效用。新的免疫测定法可用于检测急性呼吸困难患者的中区域前激素，如中区域原肾上腺髓质素（MR-proADM）和中区域原心钠肽（MR-proANP）。降钙素原、copeptin 和 D-二聚体等炎症、细菌感染和败血症的标志物似乎在呼吸困难的鉴别诊断中有用。常规和高敏肌钙蛋白不仅是急性冠状动脉综合征的诊断指标，也是急性失代偿性心力衰竭患者死亡的指标。
需要进一步进行随机对照临床试验研究，以证明在诊断、预后、成本效益评估和急性呼吸困难患者管理方面，短时间呼吸生物标志物提供的理论临床优势。
通过快速、准确的检测方法进行多标志物联合检测，可能有助于急诊医生及时识别不同的呼吸困难原因，从而提高诊断、治疗和风险分层水平。
