Omland T
Institute of Clinical Medicine, University of Oslo, Norway.
Drugs Today (Barc). 2011 Apr;47(4):303-12. doi: 10.1358/dot.2011.47.4.1533082.
The objective of the current article is to review and evaluate the diagnostic and prognostic value of a new generation of sensitive assays for cardiac troponin I and troponin T. Cardiac-specific troponins I and T are the preferred diagnostic biomarker in patients presenting with suspected acute coronary syndromes. One important limitation of previous generation assays has been the relative insensitivity in detecting myocardial injury in patients with a short duration from symptom onset to presentation in the emergency room. Recently, sensitive assays for cardiac troponins I and T have been introduced as research tools and in clinical practice. Clinical trials evaluating these assays have demonstrated that sensitivity and overall diagnostic accuracy for acute myocardial infarction, defined by the 99th percentile cardiac troponin concentration in a healthy population, is enhanced, although at the cost of reduced specificity. Not surprisingly, the relative benefit compared to previous generation assays is greatest for those patients presenting early after symptom onset. A number of cardiac conditions other than acute coronary syndromes, as well as several noncardiac conditions, are associated with elevation of circulating cardiac troponins. Thus, with the use of more sensitive assays, clinical context and serial testing to document a rise and/or fall in concentrations will be increasingly important for correct interpretation of troponin results.
本文的目的是回顾和评估新一代心肌肌钙蛋白I和肌钙蛋白T敏感检测方法的诊断和预后价值。心脏特异性肌钙蛋白I和T是疑似急性冠状动脉综合征患者首选的诊断生物标志物。上一代检测方法的一个重要局限性是，对于从症状发作到在急诊室就诊时间较短的患者，检测心肌损伤的相对敏感性较低。最近，心肌肌钙蛋白I和T的敏感检测方法已作为研究工具引入临床实践。评估这些检测方法的临床试验表明，以健康人群心肌肌钙蛋白浓度第99百分位数定义的急性心肌梗死的敏感性和总体诊断准确性有所提高，尽管代价是特异性降低。不出所料，与上一代检测方法相比，对于症状发作后早期就诊的患者，相对益处最大。除急性冠状动脉综合征外，许多心脏疾病以及一些非心脏疾病都与循环心肌肌钙蛋白升高有关。因此，随着更敏感检测方法的使用，临床背景和连续检测以记录浓度的升高和/或下降对于正确解读肌钙蛋白结果将变得越来越重要。
