Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, 127 S. San Vicente Blvd, Suite A3206, Los Angeles, CA, 90048, USA.
Biol Sex Differ. 2018 Sep 17;9(1):43. doi: 10.1186/s13293-018-0201-y.
Since 1984, each year, more women than men die of ischemic heart disease (IHD) and heart failure (HF), yet more men are diagnosed. Because biomarker assessment is often the first diagnostic employed in such patients, understanding biomarker differences in men vs. women may improve female morbidity and mortality rates.Some key examples of cardiac biomarker utility based on sex include contemporary use of "unisex" troponin reference intervals under-diagnosing myocardial necrosis in women; greater use of hsCRP in the setting of acute coronary syndrome (ACS) could lead to better stratification in women; and greater use of BNP with sex-specific thresholds in ACS could also lead to more timely risk stratification in women.Accurate diagnosis, appropriate risk management, and monitoring are key in the prevention and treatment of cardiovascular diseases; however, the assessment tools used must also be useful or at least assessed for utility in both sexes. In other words, going forward, we need to evaluate sex-specific reference intervals or cutoffs for laboratory tests used to assess cardiovascular disease to help close the diagnostic gap between men and women.
自 1984 年以来，每年死于缺血性心脏病（IHD）和心力衰竭（HF）的女性多于男性，但男性的诊断人数却更多。由于生物标志物评估通常是此类患者的首次诊断手段，因此了解男性和女性之间的生物标志物差异可能会提高女性的发病率和死亡率。一些基于性别的心脏生物标志物效用的关键示例包括：当前使用“男女通用”肌钙蛋白参考区间在女性中诊断心肌坏死的能力不足；在急性冠状动脉综合征（ACS）中更频繁地使用 hsCRP 可能会更好地对女性进行分层；在 ACS 中使用具有性别特异性阈值的 BNP 也可能会导致对女性进行更及时的风险分层。准确的诊断、适当的风险管理和监测是预防和治疗心血管疾病的关键；然而，使用的评估工具也必须在两性中都有用或至少评估其效用。换句话说，我们需要评估用于评估心血管疾病的实验室检测的性别特异性参考区间或截止值，以帮助缩小男女之间的诊断差距。
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