Sze Julie, Mooney John, Barzi Federica, Hillis Graham S, Chow Clara K
The George Institute for Global Health, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
The George Institute for Global Health, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.
Heart Lung Circ. 2016 Mar;25(3):217-28. doi: 10.1016/j.hlc.2015.09.001. Epub 2015 Oct 9.
The clinical relevance of minor elevations of cardiac troponin (cTn) in the general population remains uncertain. The objective of this systematic review was to examine the literature and evaluate the prevalence of raised cTn in asymptomatic, community populations and explore the strength of the relationship between cTn and cardiovascular mortality amongst those studied.
Studies were identified by searching Medline, Embase, CINAHL, EBM Reviews, Cochrane Library and using the "related citation" search tool in PubMed from inception through August 2014. Prospective cohort studies of asymptomatic individuals recruited from the community (age ≥ 18 years) that assessed the relationship between cTn levels and mortality or cardiovascular events were included.
Twenty-one prospective studies involving 64,855 participants were identified. An elevated cTn measurement (>99th percentile) occurred in 5% of individuals and was associated with a tripling of risk of mortality (adjusted RR 3.07, 95% confidence interval [CI] 2.32-4.06) and cardiovascular mortality (adjusted RR 3.30, 95% CI 1.77-6.12). In studies including high sensitivity assays, cTn was detectable in 58% of individuals. A detectable cardiac troponin T (cTnT) was also associated with an increased risk of cardiovascular mortality (adjusted RR 1.32, 95% CI 1.10 - 1.59). The risk increased with increasing cTnT level.
Elevated troponin in asymptomatic individuals in the community is associated with a tripling of risk of all-cause and cardiovascular mortality. Cardiac troponin T (cTnT) is generally not measured in this group of patients, but may potentially have utility in predicting risk in this population. Further research is required to assess if this risk is modifiable with usual primary prevention treatments.
一般人群中心脏肌钙蛋白（cTn）轻度升高的临床相关性仍不确定。本系统评价的目的是检索文献，评估无症状社区人群中cTn升高的患病率，并探讨所研究人群中cTn与心血管死亡率之间关系的强度。
通过检索Medline、Embase、CINAHL、循证医学评论、Cochrane图书馆，并使用PubMed中的“相关引文”检索工具，从创刊至2014年8月识别研究。纳入从社区招募的无症状个体（年龄≥18岁）的前瞻性队列研究，这些研究评估了cTn水平与死亡率或心血管事件之间的关系。
确定了21项涉及64855名参与者的前瞻性研究。5%的个体cTn测量值升高（>第99百分位数），这与死亡风险增加两倍（调整后RR 3.07，95%置信区间[CI] 2.32 - 4.06）和心血管死亡率增加两倍（调整后RR 3.30，95% CI 1.77 - 6.12）相关。在包括高灵敏度检测的研究中，58%的个体可检测到cTn。可检测到的心肌肌钙蛋白T（cTnT）也与心血管死亡率增加相关（调整后RR 1.32，95% CI 1.10 - 1.59）。风险随着cTnT水平的升高而增加。
社区无症状个体中肌钙蛋白升高与全因死亡率和心血管死亡率增加两倍相关。这组患者一般不检测心肌肌钙蛋白T（cTnT），但其可能在预测该人群风险方面具有效用。需要进一步研究以评估这种风险是否可通过常规一级预防治疗来改变。
