Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
PLoS One. 2021 Feb 26;16(2):e0247946. doi: 10.1371/journal.pone.0247946. eCollection 2021.
The risk of myocardial infarction (MI) increases during pregnancy, particularly in women with pre-eclampsia. MI is diagnosed by measuring high blood levels of cardiac-specific troponin (cTn), although this may be elevated in women with pre-eclampsia without MI, which increases diagnostic uncertainty. It is unclear how much cTn is elevated in uncomplicated and complicated pregnancy, which may affect whether the existing reference intervals can be used in pregnant women. Previous reviews have not investigated high-sensitivity troponin in pregnancy, compared to older, less sensitive methods.
Electronic searches using the terms "troponin I" or "troponin T", and "pregnancy", "pregnancy complications" or "obstetrics". cTn levels were extracted from studies of women with uncomplicated pregnancies or pre-eclampsia.
The search identified ten studies with 1581 women. Eight studies used contemporary methods that may be too insensitive to use reliably in this clinical setting. Two studies used high-sensitivity assays, with one reporting an elevation in troponin I (TnI) in pre-eclampsia compared to uncomplicated pregnancy, and the other only examining women with pre-eclampsia. Seven studies compared cTn between women with pre-eclampsia or uncomplicated pregnancy using any assay. Seven studies showed elevated TnI in pre-eclampsia compared to uncomplicated pregnancy or non-pregnant women. One study measured troponin T (TnT) in pregnancy but did not examine pre-eclampsia.
TnI appears to be elevated in pre-eclampsia, irrespective of methodology, which may reflect the role of cardiac stress in this condition. TnI may be similar in healthy pregnant and non-pregnant women, but we found no literature reporting pregnancy-specific reference intervals using high-sensitivity tests. This limits broader application of cTn in pregnancy. There is a need to define reference intervals for cTn in pregnant women, which should involve serial sampling throughout pregnancy, with careful consideration for gestational age and body mass index, which cause dynamic changes in normal maternal physiology.
怀孕期间心肌梗死（MI）的风险增加，特别是在患有子痫前期的女性中。 MI 的诊断通过测量心脏特异性肌钙蛋白（cTn）的血液高浓度来进行，尽管在没有 MI 的子痫前期女性中可能会升高，这增加了诊断的不确定性。目前尚不清楚在无并发症和复杂妊娠中 cTn 的升高程度，这可能会影响是否可以将现有的参考区间用于孕妇。以前的综述没有调查过妊娠期间的高敏肌钙蛋白，与较旧的、不太敏感的方法相比。
使用术语“肌钙蛋白 I”或“肌钙蛋白 T”以及“妊娠”，“妊娠并发症”或“产科”进行电子搜索。从患有无并发症妊娠或子痫前期的女性的研究中提取 cTn 水平。
搜索确定了十项研究，涉及 1581 名女性。八项研究使用了可能在这种临床环境中无法可靠使用的现代方法。两项研究使用了高敏测定法，一项研究报告了与无并发症妊娠相比，子痫前期中肌钙蛋白 I（TnI）升高，另一项仅检查了子痫前期的女性。七项研究使用任何测定法比较了子痫前期或无并发症妊娠之间的 cTn。七项研究显示，与无并发症妊娠或非妊娠女性相比，子痫前期中 TnI 升高。一项研究测量了妊娠中的肌钙蛋白 T（TnT），但未检查子痫前期。
TnI 在子痫前期中似乎升高，无论方法如何，这可能反映了心脏应激在这种情况下的作用。 TnI 在健康的孕妇和非孕妇中可能相似，但我们没有发现文献报道使用高敏检测法的妊娠特异性参考区间。这限制了 cTn 在妊娠中的广泛应用。需要为孕妇定义 cTn 的参考区间，这应该包括整个妊娠期间的连续采样，并仔细考虑会导致正常母体生理发生动态变化的妊娠年龄和体重指数。
