Kossaify Antoine, Garcia Annie, Succar Sami, Ibrahim Antoine, Moussallem Nicolas, Kossaify Mikhael, Grollier Gilles
CCU Acute Cardiac Care Unit (CCU), Cardiology Division, University Hospital Notre Dame de Secours, St. Charbel Street, Byblos, Lebanon.
Biomark Insights. 2013 Sep 3;8:115-26. doi: 10.4137/BMI.S12703. eCollection 2013.
Biomarkers in acute cardiac care are gaining increasing interest given their clinical benefits. This study is a review of the major conditions in acute cardiac care, with a focus on biomarkers for diagnostic and prognostic assessment. Through a PubMed search, 110 relevant articles were selected. The most commonly used cardiac biomarkers (cardiac troponin, natriuretic peptides, and C-reactive protein) are presented first, followed by a description of variable acute cardiac conditions with their relevant biomarkers. In addition to the conventional use of natriuretic peptides, cardiac troponin, and C-reactive protein, other biomarkers are outlined in variable critical conditions that may be related to acute cardiac illness. These include ST2 and chromogranin A in acute dyspnea and acute heart failure, matrix metalloproteinase in acute chest pain, heart-type fatty acid binding protein in acute coronary syndrome, CD40 ligand and interleukin-6 in acute myocardial infarction, blood ammonia and lactate in cardiac arrest, as well as tumor necrosis factor-alpha in atrial fibrillation. Endothelial dysfunction, oxidative stress and inflammation are involved in the physiopathology of most cardiac diseases, whether acute or chronic. In summary, natriuretic peptides, cardiac troponin, C-reactive protein are currently the most relevant biomarkers in acute cardiac care. Point-of-care testing and multi-markers use are essential for prompt diagnostic approach and tailored strategic management.
鉴于生物标志物在临床方面的益处，其在急性心脏护理中的应用越来越受到关注。本研究回顾了急性心脏护理中的主要病症，重点关注用于诊断和预后评估的生物标志物。通过PubMed搜索，选取了110篇相关文章。首先介绍了最常用的心脏生物标志物（心肌肌钙蛋白、利钠肽和C反应蛋白），随后描述了各种急性心脏病症及其相关生物标志物。除了利钠肽、心肌肌钙蛋白和C反应蛋白的常规应用外，还概述了在可能与急性心脏疾病相关的各种危急病症中使用的其他生物标志物。这些生物标志物包括急性呼吸困难和急性心力衰竭中的ST2和嗜铬粒蛋白A、急性胸痛中的基质金属蛋白酶、急性冠状动脉综合征中的心脏型脂肪酸结合蛋白、急性心肌梗死中的CD40配体和白细胞介素-6、心脏骤停中的血氨和乳酸，以及心房颤动中的肿瘤坏死因子-α。大多数心脏疾病，无论急性还是慢性，其病理生理过程都涉及内皮功能障碍、氧化应激和炎症。总之，利钠肽、心肌肌钙蛋白、C反应蛋白目前是急性心脏护理中最相关的生物标志物。即时检测和多标志物联合使用对于快速诊断和制定个性化的战略管理至关重要。
