Neves Ana L, Henriques-Coelho Tiago, Leite-Moreira Adelino, Areias José C
Department of Paediatric Cardiology, São João Hospital, Porto, Portugal.
Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal.
Heart Fail Rev. 2016 Nov;21(6):771-781. doi: 10.1007/s10741-016-9567-2.
The aim of this article is to evaluate the clinical utility of cardiac injury biomarkers in paediatric age. In December 2015, a literature search was performed (PubMed access to MEDLINE citations; http://www.ncbi.nlm.nih.gov/PubMed/ ). The search strategy included the following medical subject headings and text terms for the key words: "cardiac injury biomarkers", "creatine kinase-MB", "myoglobin", "troponin", "children", "neonate/s", "newborn/s", "infant/s" and echocardiography. In the paediatric population, troponins show a good correlation with the extent of myocardial damage following cardiac surgery and cardiotoxic medication and can be used as predictors of subsequent cardiac recovery and mortality. Elevation of cardiac injury biomarkers may also have diagnostic value in cases when cardiac contusion or pericarditis is suspected. Cardiac injury biomarkers are very sensitive markers for the detection of myocardial injury and have been studied in healthy newborns, after tocolysis, intrauterine growth restriction, respiratory distress and asphyxia. The proportion of newborns with elevated troponin was higher than that in ill infants, children, and adolescents and in healthy adults, suggesting that myocardial injury, although clinically occult, is common in this young age group. Results suggest that significant elevation of cord troponin is an excellent early predictor of severity of hypoxic-ischaemic encephalopathy and mortality in term infants. Cardiac biomarkers may also benefit centres without on-site echocardiography with evidence showing good correlation with echo-derived markers of myocardial function. Further studies are needed to better clarify the role of cardiac biomarkers in paediatric age and their correlation with echocardiographic parameters.
本文旨在评估心脏损伤生物标志物在儿童期的临床应用价值。2015年12月，进行了一项文献检索（通过PubMed访问MEDLINE引文；http://www.ncbi.nlm.nih.gov/PubMed/ ）。检索策略包括以下医学主题词和关键词的文本词：“心脏损伤生物标志物”、“肌酸激酶同工酶MB”、“肌红蛋白”、“肌钙蛋白”、“儿童”、“新生儿”、“婴儿”以及超声心动图。在儿科人群中，肌钙蛋白与心脏手术后及心脏毒性药物治疗后的心肌损伤程度具有良好的相关性，可作为后续心脏恢复和死亡率的预测指标。在怀疑有心脏挫伤或心包炎的情况下，心脏损伤生物标志物的升高也可能具有诊断价值。心脏损伤生物标志物是检测心肌损伤的非常敏感的标志物，并且已经在健康新生儿、保胎治疗后、宫内生长受限、呼吸窘迫和窒息等情况下进行了研究。肌钙蛋白升高的新生儿比例高于患病婴儿、儿童、青少年以及健康成年人，这表明心肌损伤在这个年轻年龄组中虽然临床上不易察觉，但却很常见。结果表明，脐血肌钙蛋白的显著升高是足月儿缺氧缺血性脑病严重程度和死亡率的极佳早期预测指标。心脏生物标志物也可能使没有现场超声心动图设备的中心受益，有证据表明其与超声心动图得出的心肌功能标志物具有良好的相关性。需要进一步研究以更好地阐明心脏生物标志物在儿童期的作用及其与超声心动图参数的相关性。
