Roos Andreas, Holzmann Martin J
Department of Medicine, Karolinska Institutet, Solna, SE-171 71 Stockholm, Sweden; Functional area of Emergency Medicine, Karolinska University Hospital, Huddinge, SE-141 86, Stockholm, Sweden.
Department of Medicine, Karolinska Institutet, Solna, SE-171 71 Stockholm, Sweden; Functional area of Emergency Medicine, Karolinska University Hospital, Huddinge, SE-141 86, Stockholm, Sweden.
Clin Biochem. 2018 Apr;54:18-24. doi: 10.1016/j.clinbiochem.2018.02.003. Epub 2018 Feb 13.
Recent studies have suggested that there may be large diurnal variation in cardiac troponin T (cTnT) concentrations measured with a high sensitive assay.
To investigate if clinically relevant diurnal variation in cTnT concentrations is present in patients with chest pain in the emergency department (ED).
We included all patients with chest pain, but no myocardial infarction (MI), and no other acute condition that may affect troponin concentrations in the ED at Karolinska University Hospital, Stockholm, Sweden, 2011-2014. Time periods for blood sampling were: 00.00-03.59 am, 04.00-07.59 am, 08.00-11.59 am, 00.00-03.59 pm, 04.00-07.59 pm, and 08.00-11.59 pm. Negative binomial regression models were used to calculate least-square means of admission cTnT concentrations with 95% confidence intervals (CIs).
A total of 19,460 patients were included with a mean age of 54 ± 16 years. Patients who arrived during the night were younger, but other characteristics were similar among the time periods. The greatest mean admission cTnT concentrations for men (9.0 ng/l, 95% CI, 8.7-9.3), and women (8.0 ng/l, 95% CI, 7.8-8.2) were found at 08.00-11.59 am. After adjustment for age and estimated glomerular filtration rate, no significant diurnal variation in admission cTnT concentrations was observed.
In a cohort of unselected patients with chest pain, and no acute condition affecting troponin admission concentrations, we found no evidence of clinically relevant diurnal variation in admission cTnT concentrations. There is no need to take the time point when blood is drawn into account in the assessment of admission cTnT concentrations in the ED.
近期研究表明，采用高敏检测法测得的心肌肌钙蛋白T（cTnT）浓度可能存在较大的日间变化。
调查急诊科（ED）胸痛患者的cTnT浓度是否存在具有临床意义的日间变化。
纳入2011年至2014年期间在瑞典斯德哥尔摩卡罗林斯卡大学医院急诊科就诊的所有胸痛患者，但排除心肌梗死（MI）患者以及其他可能影响肌钙蛋白浓度的急性疾病患者。采血时间段为：凌晨00:00 - 03:59、上午04:00 - 07:59、上午08:00 - 11:59、下午00:00 - 03:59、下午04:00 - 07:59以及晚上08:00 - 11:59。采用负二项回归模型计算入院时cTnT浓度的最小二乘均值及其95%置信区间（CI）。
共纳入19460例患者，平均年龄为54 ± 16岁。夜间就诊的患者年龄较小，但各时间段的其他特征相似。男性（9.0 ng/l，95% CI，8.7 - 9.3）和女性（8.0 ng/l，95% CI，7.8 - 8.2）入院时cTnT浓度的最高均值出现在上午08:00 - 11:59。在对年龄和估算肾小球滤过率进行校正后，未观察到入院时cTnT浓度存在显著的日间变化。
在一组未经选择的胸痛患者中，且不存在影响肌钙蛋白入院浓度的急性疾病，我们未发现入院时cTnT浓度存在具有临床意义的日间变化的证据。在急诊科评估入院时cTnT浓度时，无需考虑采血时间点。
