Lindner Gregor, Pfortmueller Carmen Andrea, Braun Christian Tasso, Exadaktylos Aristomenis Konstantinos
Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland,
Intern Emerg Med. 2014 Apr;9(3):335-9. doi: 10.1007/s11739-013-1030-y. Epub 2013 Dec 11.
To systematically investigate putative causes of non-coronary high-sensitive troponin elevations in patients presenting to a tertiary care emergency department. In this cross-sectional analysis, patients who received serial measurements of high-sensitive troponin T between 1 August 2010 and 31 October 2012 at the Department of Emergency Medicine were included. The following putative causes were considered to be associated with non-acute coronary syndrome-related increases in high-sensitive troponin T: acute pulmonary embolism, renal insufficiency, aortic dissection, heart failure, peri-/myocarditis, strenuous exercise, rhabdomyolysis, cardiotoxic chemotherapy, high-frequency ablation therapy, defibrillator shocks, cardiac infiltrative disorders (e.g., amyloidosis), chest trauma, sepsis, shock, exacerbation of chronic obstructive pulmonary disease, and diabetic ketoacidosis. During the study period a total of 1,573 patients received serial measurements of high-sensitive troponin T. Of these, 175 patients were found to have acute coronary syndrome leaving 1,398 patients for inclusion in the study. In 222 (30 %) of patients, no putative cause described in the literature could be attributed to the elevation in high-sensitive troponin T observed. The most commonly encountered mechanism underlying the troponin T elevation was renal insufficiency that was present in 286 patients (57 %), followed by cerebral ischemia in 95 patients (19 %), trauma in 75 patients (15 %) and heart failure in 41 patients (8 %). Non-acute coronary syndrome-associated elevation of high-sensitive troponin T levels is commonly observed in the emergency department. Renal insufficiency and acute cerebral events are the most common conditions associated with high-sensitive troponin T elevation.
系统调查三级护理急诊科就诊患者非冠状动脉性高敏肌钙蛋白升高的可能原因。在这项横断面分析中，纳入了2010年8月1日至2012年10月31日期间在急诊科接受高敏肌钙蛋白T系列测量的患者。以下可能原因被认为与非急性冠状动脉综合征相关的高敏肌钙蛋白T升高有关：急性肺栓塞、肾功能不全、主动脉夹层、心力衰竭、心包炎/心肌炎、剧烈运动、横纹肌溶解、心脏毒性化疗、高频消融治疗、除颤器电击、心脏浸润性疾病（如淀粉样变性）、胸部创伤、脓毒症、休克、慢性阻塞性肺疾病加重以及糖尿病酮症酸中毒。在研究期间，共有1573例患者接受了高敏肌钙蛋白T的系列测量。其中，175例患者被发现患有急性冠状动脉综合征，其余1398例患者纳入本研究。在222例（30%）患者中，文献中描述的任何可能原因都无法解释所观察到的高敏肌钙蛋白T升高。肌钙蛋白T升高最常见的潜在机制是肾功能不全，有286例患者（57%）存在，其次是脑缺血95例患者（19%）、创伤75例患者（15%）和心力衰竭41例患者（8%）。在急诊科常见非急性冠状动脉综合征相关的高敏肌钙蛋白T水平升高。肾功能不全和急性脑部事件是与高敏肌钙蛋白T升高相关的最常见情况。
