Fondazione CNR-Regione Toscana G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy.
Clin Chem Lab Med. 2021 Oct 25;60(1):18-32. doi: 10.1515/cclm-2021-0976. Print 2022 Jan 26.
Apparently healthy children often complain of chest pain, especially after physical exercise. Cardiac biomarker levels are often measured, but the clinical relevance of these assays in children is still debated, even when a cardiac disease is present. Coronary artery disease is exceedingly rare in children, but elevated circulating levels of cardiac troponin I (cTnI) and T (cTnT) in an acute setting may help detect heart failure due to an unknown cardiac disorder, or worsening heart failure, particularly in combination with other biomarkers such as B-type natriuretic peptides. However, the interpretation of biomarkers is often challenging, especially when institutions transition from conventional cTn assays to high-sensitivity (hs-cTn) methods, as well demonstrated in the emergency setting for adult patients. From a clinical perspective, the lack of established reference values in the pediatric age is the main problem limiting the use of hs-cTn methods for the diagnosis and managements of cardiac diseases in infants, children and adolescents. This review aims to discuss the possibility to use hs-cTnI and hs-cTnT to detect cardiac disease and to explore age-related differences in biomarker levels in the pediatric age. We start from some analytical and pathophysiological considerations related to hs-cTn assays. Then, after a systematic literature search, we discuss the current evidence and possible limitations of hs-cTn assay as indicators of cardiac disease in the most frequently cardiac disease in pediatric setting.
看似健康的儿童常诉胸痛，尤其是在体力活动后。常测量心脏生物标志物水平，但即使存在心脏疾病，这些检测在儿童中的临床相关性仍存在争议。儿童中极罕见冠状动脉疾病，但在急性情况下循环中升高的心脏肌钙蛋白 I（cTnI）和 T（cTnT）水平可能有助于发现未知心脏疾病导致的心衰，或心衰恶化，尤其是与 B 型利钠肽等其他生物标志物结合时。然而，生物标志物的解释通常具有挑战性，尤其是当机构从传统 cTn 检测方法过渡到高敏（hs-cTn）方法时，成人患者的急诊情况就很好地证明了这一点。从临床角度来看，儿科中缺乏既定的参考值是限制 hs-cTn 方法用于婴儿、儿童和青少年心脏疾病诊断和管理的主要问题。本综述旨在讨论使用 hs-cTnI 和 hs-cTnT 检测心脏疾病的可能性，并探讨儿科年龄相关的生物标志物水平的差异。我们从与 hs-cTn 检测相关的一些分析和病理生理学考虑开始。然后，通过系统的文献检索，我们讨论了 hs-cTn 检测作为儿科中最常见的心脏疾病的心脏疾病指标的现有证据和可能的局限性。
