Lyck Hansen Maria, Saaby Lotte, Nybo Mads, Rasmussen Lars Melholt, Thygesen Kristian, Mickley Hans, Svenstrup Poulsen Tina
Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.
Cardiology. 2012;122(4):225-9. doi: 10.1159/000339269. Epub 2012 Aug 10.
Several assays for the measurement of cardiac troponin (cTn) are available, but differences in their analytical performances may affect the diagnosis of acute myocardial infarction (MI).
A survey was conducted at all Danish departments of clinical biochemistry at hospitals receiving patients with suspected acute MI to gather information about the assay and cut-off value used. cTn was measured in blood samples from 574 patients enrolled into the Odense Chest Pain Biobank with 3 different assays: the 4th generation cTnT (cTnT(4th)), high-sensitivity cTnT (cTnT(hs); Roche Diagnostics) and cTnI (Abbott Diagnostics). To evaluate concordance, patients were dichotomised according to the 99th percentile value for each assay. Additionally, a cut-off at 50 ng/l for cTnT(hs) was used, as this is the currently employed cut-off point in Denmark.
Using a cTnT(4th) cut-off value of >0.03 µg/l, 130 patients (23%) had potential MI. With the cTnT(hs) assay and cut-off values at 50 versus 14 ng/l, respectively, 136 (24%) versus 301 (52%) patients had potential MI. With the cTnI cut-off point, 205 patients (36%) should be considered as having had an acute MI.
The use of different cTn assays and cut-off values may result in a discordant frequency of MI diagnoses. This makes efforts to harmonize cTn assays and cut-off levels mandatory.
有几种用于测量心肌肌钙蛋白（cTn）的检测方法，但它们分析性能的差异可能会影响急性心肌梗死（MI）的诊断。
对丹麦所有接收疑似急性MI患者的医院临床生化科室进行了一项调查，以收集有关所使用的检测方法和临界值的信息。在纳入欧登塞胸痛生物样本库的574例患者的血样中，用3种不同的检测方法测量cTn：第4代cTnT（cTnT(4th)）、高敏cTnT（cTnT(hs)；罗氏诊断公司）和cTnI（雅培诊断公司）。为评估一致性，根据每种检测方法的第99百分位数对患者进行二分法分类。此外，cTnT(hs)的临界值采用50 ng/l，因为这是丹麦目前采用的临界值。
使用cTnT(4th)临界值>0.03 μg/l时，130例患者（23%）有潜在MI。对于cTnT(hs)检测方法，临界值分别为50 ng/l和14 ng/l时，有潜在MI的患者分别为136例（24%）和301例（52%）。采用cTnI临界值时，205例患者（36%）应被视为发生过急性MI。
使用不同的cTn检测方法和临界值可能导致MI诊断频率不一致。这使得统一cTn检测方法和临界值水平成为必要。
