Januzzi J L
Cardiology Division and Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
HSR Proc Intensive Care Cardiovasc Anesth. 2009;1(3):22-32.
Single biomarker measurements can predict outcome after cardiac surgery. and may assist in decision making about diagnostic and therapeutic steps following surgery. Although comparative data are relatively lacking some data exist to suggest that among markers of myocardial necrosis, results from cardiac troponin (cTn) measurement may be superior for risk prediction after cardiac surgery to those from the MB isoenzyme of CK (CK-MB). Loss of cardiac troponins from necrotic myocardium is not replenished through re-expression of genes that might increase protein synthesis, and release of cTn appears to represent irreversibly damaged myocardium. Not every cardiac surgical procedure is associated with the same degree of cTn elevation and forms of cardioprotection may im-portantly affect concentrations of cTn after coronary artery bypass grafting. Similarly, less cardiac injury may occur depending on the form of anesthesia used during surgery. Great caution must be exercised when utilizing cTnT or cTnI for diagnosis of post-cardiac surgery regional acute myocardial infarction: in this context clinical factors must be applied at the risk of a false diagnosis. On the other hand, concentrations of both cTnT and cTnI have repeatedly and unequivocally been shown to be prognostic for delayed recov-ery, intensive care unit utilization, as well as short- and longer-term mortality following cardiac surgery.
单一生物标志物检测可预测心脏手术后的预后，并有助于指导术后诊断和治疗措施的决策。尽管相对缺乏比较数据，但一些数据表明，在心肌坏死标志物中，心脏肌钙蛋白（cTn）检测结果在预测心脏手术后风险方面可能优于肌酸激酶MB同工酶（CK-MB）。坏死心肌中丢失的心脏肌钙蛋白不会通过可能增加蛋白质合成的基因重新表达来补充，cTn的释放似乎代表了不可逆损伤的心肌。并非每种心脏手术都与相同程度的cTn升高相关，心脏保护形式可能会对冠状动脉搭桥术后cTn的浓度产生重要影响。同样，根据手术期间使用的麻醉形式，可能会发生较少的心脏损伤。在使用cTnT或cTnI诊断心脏手术后局部急性心肌梗死时必须格外谨慎：在这种情况下，必须考虑临床因素，以免误诊。另一方面，cTnT和cTnI的浓度已反复明确显示对心脏手术后的延迟恢复、重症监护病房的使用以及短期和长期死亡率具有预后价值。
