Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium.
Department of Pharmacy, Namur Research Institute for Life Sciences, University of Namur, Namur, Belgium.
Clin Chem Lab Med. 2021 Jan 12;59(7):1201-1211. doi: 10.1515/cclm-2020-1564. Print 2021 Jun 25.
Cardiac troponins (cTn) are the preferred biomarkers for the evaluation of myocardial injury and play a key role in the diagnosis of acute myocardial infarction (MI). Pre-analytical or analytical issues and interferences affecting troponin T and I assays are therefore of major concern given the risk of misdiagnosis. False positive troponin results have been related to various interferences including anti-troponin antibodies, heterophilic antibodies, or elevated alkaline phosphatase level. On the other hand, false negative results have been reported in the case of a large biotin intake. These interferences are characterized with erroneous but reproducible troponin results. Of interest, non-reproducible results have also been reported in the literature. In other words, if the sample is reanalyzed a second time, a significant difference in troponin results will be observed. These interferences have been named "fliers" or "outliers". Compared to the biotin interference that received major attention in the literature, troponin outliers are also able to induce harmful clinical consequences for the patient. Moreover, the prevalence of outliers in recent studies was found to be higher (0.28-0.57%) compared to the biotin interference. The aim of this systematic review is to warn clinicians about these non-reproducible results that may alter their clinical judgment. Four case reports that occurred in the Clinique of Saint-Luc Bouge are presented to attest this point. Moreover, we aimed at identifying the nature of these non-reproducible troponin results, determining their occurrence, and describing the best way for their identification.
心肌肌钙蛋白（cTn）是评估心肌损伤的首选生物标志物，在急性心肌梗死（MI）的诊断中起着关键作用。因此，考虑到误诊的风险，影响肌钙蛋白 T 和 I 检测的分析前或分析问题及干扰因素是非常重要的。假阳性肌钙蛋白结果与各种干扰因素有关，包括抗肌钙蛋白抗体、异嗜性抗体或碱性磷酸酶水平升高。另一方面，据报道，如果大量摄入生物素，也会出现假阴性结果。这些干扰具有错误但可重复的肌钙蛋白结果的特点。有趣的是，文献中也报道了不可重复的结果。换句话说，如果再次重新分析样本，将观察到肌钙蛋白结果的显著差异。这些干扰已被命名为“飞行物”或“异常值”。与文献中受到广泛关注的生物素干扰相比，肌钙蛋白异常值也可能对患者产生有害的临床后果。此外，最近的研究发现，异常值的患病率（0.28-0.57%）高于生物素干扰。本系统评价的目的是警告临床医生注意这些可能改变其临床判断的不可重复结果。介绍了在圣吕克布日医疗中心发生的四起病例报告，以证明这一点。此外，我们旨在确定这些不可重复的肌钙蛋白结果的性质，确定它们的发生，并描述识别它们的最佳方法。
