Nishimura Marin, Brann Alison, Chang Kay-Won, Maisel Alan S
Division of Cardiovascular Medicine, University of California, San Diego, 9434 Medical Center Drive, La Jolla, CA, 92037, USA.
Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
Curr Heart Fail Rep. 2018 Aug;15(4):239-249. doi: 10.1007/s11897-018-0398-4.
Cardiac biomarkers play important roles in routine evaluation of cardiac patients. But while these biomarkers can be extremely valuable, none of them should ever be used by themselves-without adding the clinical context. This paper explores the non-cardiac pathologies that can be seen with the cardiac biomarkers most commonly used.
High-sensitivity troponin assay gained FDA approval for use in the USA, and studies demonstrated its diagnostic utility can be extended to patients with renal impairment. Gender-specific cut points may be utilized for high-sensitivity troponin assays. In the realm of the natriuretic peptides, studies demonstrated states of natriuretic peptide deficiency in obesity and in subjects of African-American race. Regardless, BNP and NT-proBNP both retained prognostic utilities across a variety of comorbid conditions. We are rapidly gaining clinical evidence with use of soluble ST2 and procalcitonin levels in management of cardiac disease states. In order to get the most utility from their measurement, one must be aware of non-cardiac pathologies that may affect the levels of biomarkers as although many of these are actually true values, they may not represent the disease we are trying to delineate. A few take-home points are as follows: 1. A biomarker value should never be used without clinical context 2. Serial sampling of biomarkers is often helpful 3. Panels of biomarkers may be valuable.
心脏生物标志物在心脏病患者的常规评估中发挥着重要作用。虽然这些生物标志物可能极具价值，但在不结合临床背景的情况下，任何一种都不应单独使用。本文探讨了最常用的心脏生物标志物可能出现的非心脏病变情况。
高敏肌钙蛋白检测获得美国食品药品监督管理局（FDA）批准在美国使用，研究表明其诊断效用可扩展至肾功能不全患者。高敏肌钙蛋白检测可采用性别特异性切点值。在利钠肽领域，研究表明肥胖患者和非裔美国人存在利钠肽缺乏状态。尽管如此，脑钠肽（BNP）和N末端脑钠肽原（NT-proBNP）在各种合并症中均保留了预后效用。在心脏病状态管理中使用可溶性ST2和降钙素原水平方面，我们正在迅速积累临床证据。为了从这些检测中获得最大效用，必须了解可能影响生物标志物水平的非心脏病变情况，因为尽管其中许多实际上是真实值，但它们可能并不代表我们试图描绘的疾病。以下是一些要点：1. 生物标志物值在没有临床背景时绝不应使用；2. 生物标志物的系列采样通常很有帮助；3. 生物标志物组合可能有价值。
