Collinson Paul
Departments of Clinical Blood Sciences and Cardiology, St George's University Hospitals NHS Foundation Trust and St George's University of London, Cranmer Terrace, London SW17 0QT, UK.
Clin Chim Acta. 2020 Sep;508:234-239. doi: 10.1016/j.cca.2020.05.018. Epub 2020 May 25.
Cardiac biomarker measurements are integral to the diagnosis and management of patients presenting with breathlessness and chest pain. Measurement of B type natriuretic peptide either directly or of the N-terminal portion of the prohormone although possible by point of care testing (POCT) has largely become a laboratory test. Measurement of the cardiac troponins cardiac troponin T (cTnT) and cardiac troponin I (cTnI) can easily and accurately be performed by POCT. The situation has been complicated by the development of high sensitivity assays for cTnT and cTnI and the subsequent development of rapid rule out algorithms allowing patient categorisation and discharge on admission and 1 to 2 h following admission. This article reviews the development of POCT for cardiac biomarkers, the evidence base comparing POCT with central laboratory testing, its strengths and limitations, and how POCT fits into the world of high sensitivity troponin assays. It also discusses what evidence there is that POCT can form part of rapid decision-making strategies and how this applies in an era of algorithms based on and is derived from measurement of high sensitivity troponin in the central laboratory.
心脏生物标志物检测对于出现呼吸困难和胸痛症状的患者的诊断和管理至关重要。B型利钠肽的检测，无论是直接检测还是检测前体激素的N端部分，虽然通过即时检验（POCT）可行，但很大程度上已成为一项实验室检测。心肌肌钙蛋白，即心肌肌钙蛋白T（cTnT）和心肌肌钙蛋白I（cTnI）的检测可以通过POCT轻松、准确地进行。cTnT和cTnI高灵敏度检测方法的出现，以及随后快速排除算法的发展，使得患者在入院时以及入院后1至2小时即可进行分类和出院，这使情况变得复杂。本文回顾了心脏生物标志物POCT的发展、POCT与中心实验室检测对比的证据基础、其优势和局限性，以及POCT如何融入高灵敏度肌钙蛋白检测的领域。文章还讨论了POCT可作为快速决策策略一部分的证据，以及这在基于中心实验室高灵敏度肌钙蛋白检测并由此衍生的算法时代如何应用。
