Nursalim Alvin, Suryaatmadja Marzuki, Panggabean Marulam
Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
Acta Med Indones. 2013 Jul;45(3):240-50.
Coronary heart disease is the leading cause of cardiac related death worldwide. Therefore, early and accurate diagnosis of acute coronary syndrome is required to determine the next clinical step. The current gold standard for cardiac markers, troponin and CK-MB have their downside. The delayed increase of detectable circulating level of these markers contribute to delayed diagnosis and therapy. Novel biomarkers that rise earlier, has a good diagnosis accuracy and has additional prognostic information, are highly needed. There are some potential emerging novel biomarkers for acute myocardial infarction. High sensitivity troponin have a greater sensitivity and accuracy for detection and early exclusion of myocardial infarction, as compared to troponin. B-natriuretic peptide (BNP and NT-pro BNP) provide prognostic information in regards of mortality. Myeloperoxidase identify subjects with increased risk of cardiac events in the absence of myocardial necrosis. Dual marker strategy combining copeptin with troponin T is more accurate assay to diagnose acute myocardial infarction. The level of Growth Differentiation Factor-15 is correlated with the risk of death or myocardial infarction in the next 6 months. While, Heart-Fatty Acid Binding Protein assay is an earlier marker for myocardial necrosis and provide valuable prognostic information and can further stratify patients' risk. Novel cardiac biomarkers provide a faster exclusion of acute myocardial infarction, yet with very good accuracy. However unlike their predecessors, the clinical use of these novel cardiac biomarkers are not only limited to establishing the diagnosis of myocardial infarction. Novel cardiac biomarkers possess additional potential use, some of which are to determine patients' prognosis and to further stratify patients' risk that would determine the next step of therapy.
冠心病是全球心脏相关死亡的主要原因。因此，需要对急性冠脉综合征进行早期准确诊断，以确定下一步的临床治疗方案。目前心脏标志物的金标准——肌钙蛋白和肌酸激酶同工酶（CK-MB）存在不足之处。这些标志物可检测的循环水平延迟升高会导致诊断和治疗延迟。因此，迫切需要能够更早升高、具有良好诊断准确性并能提供额外预后信息的新型生物标志物。目前有一些潜在的急性心肌梗死新型生物标志物正在崭露头角。与传统肌钙蛋白相比，高敏肌钙蛋白在检测和早期排除心肌梗死方面具有更高的灵敏度和准确性。B型利钠肽（BNP和NT-pro BNP）可提供有关死亡率的预后信息。髓过氧化物酶可识别无心肌坏死但心脏事件风险增加的患者。将 copeptin 与肌钙蛋白T联合使用的双标志物策略在诊断急性心肌梗死方面是更准确的检测方法。生长分化因子-15的水平与未来6个月内死亡或心肌梗死的风险相关。而心脏脂肪酸结合蛋白检测是心肌坏死的早期标志物，可提供有价值的预后信息，并能进一步对患者的风险进行分层。新型心脏生物标志物能够更快地排除急性心肌梗死，且准确性很高。然而，与之前的标志物不同，这些新型心脏生物标志物的临床应用不仅限于心肌梗死的诊断。新型心脏生物标志物还有其他潜在用途，其中一些用途是确定患者的预后，并进一步对患者的风险进行分层，从而决定下一步的治疗方案。
