Al-Otaiby Mohammed A, Al-Amri Hussein S, Al-Moghairi Abdulrahman M
PSCC, Adult Cardiology, P.O. Box 27656, Riyadh 11427, Saudi Arabia.
J Saudi Heart Assoc. 2011 Jan;23(1):3-11. doi: 10.1016/j.jsha.2010.10.001. Epub 2010 Oct 20.
Troponins are regulatory proteins that form the cornerstone of muscle contraction. The amino acid sequences of cardiac troponins differentiate them from that of skeletal muscles, allowing for the development of monoclonal antibody-based assay of troponin I (TnI) and troponin T (TnT). Along with the patient history, physical examination and electrocardiography, the measurement of highly sensitive and specific cardiac troponin has supplanted the former gold standard biomarker (creatine kinase-MB) to detect myocardial damage and estimate the prognosis of patients with ischemic heart disease. The current guidelines for the diagnosis of non-ST segment elevation myocardial infarction are largely based on an elevated troponin level. The implementation of these new guidelines in clinical practice has led to a substantial increase in the frequency of myocardial infarction diagnosis. Automated assays using cardiac-specific monoclonal antibodies to cardiac TnI and TnT are commercially available. They play a major role in the evaluation of myocardial injury and prediction of cardiovascular outcome in cardiac and non-cardiac causes. In this review we discuss the clinical applications of cardiac troponins and the interpretation of elevated levels in the context of various clinical settings.
肌钙蛋白是构成肌肉收缩基石的调节蛋白。心肌肌钙蛋白的氨基酸序列使其有别于骨骼肌肌钙蛋白，这使得基于单克隆抗体的肌钙蛋白I（TnI）和肌钙蛋白T（TnT）检测方法得以发展。除患者病史、体格检查和心电图外，高灵敏度和特异性的心肌肌钙蛋白检测已取代了此前用于检测心肌损伤和评估缺血性心脏病患者预后的金标准生物标志物（肌酸激酶同工酶MB）。目前非ST段抬高型心肌梗死的诊断指南很大程度上基于肌钙蛋白水平的升高。这些新指南在临床实践中的实施导致心肌梗死诊断频率大幅增加。使用针对心肌TnI和TnT的心脏特异性单克隆抗体的自动化检测方法已商业化。它们在评估心肌损伤以及预测心脏和非心脏病因导致的心血管结局方面发挥着重要作用。在本综述中，我们讨论了心肌肌钙蛋白的临床应用以及在各种临床情况下对升高水平的解读。
