Chaulin Aleksey
Samara State Medical University. Russia. CAMPA..
Rev Fac Cien Med Univ Nac Cordoba. 2021 Nov 29;78(4):415-422. doi: 10.31053/1853.0605.v78.n4.32988.
The expansion and discovery of new diagnostic possibilities for the use of many biomarkers of cardiovascular diseases (CVDs), including cardiospecific troponin isoforms (cTnI, cTnT), is due to improved laboratory methods for their determination. Throughout a long history of the creation and improvement of immunochemical methods for the determination of cTnI and cTnT, significant changes were observed in the concept of biology and its diagnostic value as CVD biomarkers. The obsolete methods of detection of cTnI, cTnT, named low sensitivity and moderate, were distinguished by a relatively low sensitivity, which led to the confirmation late in the diagnosis of acute myocardial infarction (AMI) and, therefore, such methods were gradually replaced by new methods of high and moderate sensitivity, such as definitions of methods, ultra-sensitive (hs-cTnI, hs-cTnT). With the introduction of hs-cTnI and hs-cTnT in clinical practice, the possibility of early diagnosis and exclusion of AMI through the evaluation of the kinetics of the concentration of hs-cTnI and hs-cTnT in the first hours (0-1 hour, 0-2 hours, 0-3 hours) from the moment the patient enters the emergency room. In addition, some of our ideas about the biology of cardiac troponins have changed, and promising new opportunities for their use in medicine have emerged. This manuscript analyzes the key analytical characteristics of hs-cTnI and hs-cTnT detection methods compared to moderately sensitive methods, and reports on new biological data and some new diagnostic possibilities for the use of hs-cTnI and hs-cTnT in modern clinical practice.
心血管疾病(CVD)多种生物标志物,包括心肌特异性肌钙蛋白同工型(cTnI、cTnT),其新诊断可能性的拓展与发现,得益于用于测定它们的实验室方法的改进。在创建和改进用于测定cTnI和cTnT的免疫化学方法的漫长历史中,作为CVD生物标志物,其生物学概念及其诊断价值发生了显著变化。检测cTnI、cTnT的过时方法,即低灵敏度和中等灵敏度方法,其特点是灵敏度相对较低,这导致急性心肌梗死(AMI)诊断延迟,因此,此类方法逐渐被高灵敏度和中等灵敏度的新方法所取代,如超敏(hs-cTnI、hs-cTnT)等方法。随着hs-cTnI和hs-cTnT在临床实践中的引入,通过评估患者进入急诊室后最初几小时(0 - 1小时、0 - 2小时、0 - 3小时)hs-cTnI和hs-cTnT浓度的动力学,实现了早期诊断和排除AMI的可能性。此外,我们对心肌肌钙蛋白生物学的一些认识也发生了变化,并且出现了将其用于医学的有前景的新机会。本手稿分析了与中等灵敏度方法相比hs-cTnI和hs-cTnT检测方法的关键分析特性,并报告了新的生物学数据以及hs-cTnI和hs-cTnT在现代临床实践中的一些新诊断可能性。