Perrone Marco A, Storti Simona, Salvadori Stefano, Pecori Alessandro, Bernardini Sergio, Romeo Francesco, Guccione Paolo, Clerico Aldo
Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS.
Division of Cardiology, University of Rome Tor Vergata, Rome.
J Cardiovasc Med (Hagerstown). 2021 Nov 1;22(11):797-805. doi: 10.2459/JCM.0000000000001155.
The most recent international guidelines recommend the measurement of cardiac troponin I (cTnI) and cardiac troponin T (cTnT) using high-sensitivity methods (hs-cTn) for the detection of myocardial injury and the differential diagnosis of acute coronary syndromes. Myocardial injury is a prerequisite for the diagnosis of acute myocardial infarction, but also a distinct entity. The 2018 Fourth Universal Definition of Myocardial Infarction states that myocardial injury is detected when at least one value above the 99th percentile upper reference limit is measured in a patient with high-sensitivity methods for cTnI or cTnT. Not infrequently, increased hs-cTnT levels are reported in patients with congenital or chronic neuromuscular diseases, while the hs-cTnI values are often in the normal range. Furthermore, some discrepancies between the results of laboratory tests for the two troponins are occasionally found in individuals apparently free of cardiac diseases, and also in patients with cardiac diseases. In this review article, authors discuss the biochemical, pathophysiological and analytical mechanisms which may cause discrepancies between hs-cTnI and hs-cTnT test results.
最新的国际指南建议使用高敏方法（hs-cTn）检测心肌肌钙蛋白I（cTnI）和心肌肌钙蛋白T（cTnT），以诊断心肌损伤和鉴别诊断急性冠脉综合征。心肌损伤是诊断急性心肌梗死的前提条件，也是一个独立的实体。2018年《心肌梗死的第四次全球定义》指出，当使用高敏方法检测cTnI或cTnT时，在患者中至少有一个值高于第99百分位的参考上限时，即检测到心肌损伤。先天性或慢性神经肌肉疾病患者中，hs-cTnT水平升高的情况并不少见，而hs-cTnI值通常在正常范围内。此外，在明显无心脏病的个体以及心脏病患者中，偶尔也会发现两种肌钙蛋白的实验室检测结果存在一些差异。在这篇综述文章中，作者讨论了可能导致hs-cTnI和hs-cTnT检测结果出现差异的生化、病理生理和分析机制。
