应激性心肌病与急性冠状动脉综合征的鉴别诊断——新型心血管生物标志物用于更具选择性分诊的前瞻性分析

Differential Diagnosis between Takotsubo Syndrome and Acute Coronary Syndrome-A Prospective Analysis of Novel Cardiovascular Biomarkers for a More Selective Triage.

作者信息

Topf Albert, Mirna Moritz, Paar Vera, Motloch Lukas J, Bacher Nina, Franz Marcus, Hoppe Uta C, Kretzschmar Daniel, Lichtenauer Michael

机构信息

Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria.

Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, 07743 Jena, Germany.

出版信息

J Clin Med. 2022 May 25;11(11):2974. doi: 10.3390/jcm11112974.

DOI:10.3390/jcm11112974

PMID:35683362

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9180967/

Abstract

INTRODUCTION

Takotsubo syndrome (TTS) is clinically indistinguishable from an ACS. Despite the implementation of clinical scoring systems and novel biomarkers, coronary angiography currently remains necessary for differential diagnosis.

METHODS

93 patients with chest pain and the suspicion of TTS were enrolled in two study centers. Fetuin-A, IGFBP-2, Galectin-3, and TNF α were determined in serum samples, collected within 24 h after the onset of symptoms. Serum levels of biomarkers were analyzed for the differential diagnostic value between TTS and ACS.

RESULTS

Compared to TTS, patients with ACS had significantly lower serum levels of Fetuin-A and IGFBP-2. The cut-off value of Fetuin-A for the identification of TTS compared to ACS was 55.74 μg/mL (sensitivity: 100.0%, specificity: 82.6%, PPV: 63.2%, NPV: 100.0%). An optimal cut-off value for IGFBP-2 for the differential diagnosis between TTS and ACS was determined as 171.77 ng/mL (sensitivity: 76.0%, specificity: 82.6%, PPV: 76.4%, NPV 72.7%).

CONCLUSION

Fetuin-A and IGFBP-2 might facilitate the triage between TTS and ACS and could be therefore of great benefit for the guidance of treatment.

摘要

引言

应激性心肌病（TTS）在临床上与急性冠状动脉综合征（ACS）难以区分。尽管实施了临床评分系统和新型生物标志物，但目前冠状动脉造影仍是鉴别诊断所必需的。

方法

两个研究中心纳入了93例胸痛且疑似TTS的患者。在症状发作后24小时内采集血清样本，测定胎球蛋白-A、胰岛素样生长因子结合蛋白-2（IGFBP-2）、半乳糖凝集素-3和肿瘤坏死因子α（TNFα）。分析生物标志物的血清水平，以确定其在TTS和ACS之间的鉴别诊断价值。

结果

与TTS患者相比，ACS患者的血清胎球蛋白-A和IGFBP-2水平显著降低。与ACS相比，用于识别TTS的胎球蛋白-A临界值为55.74μg/mL（敏感性：100.0%，特异性：82.6%，阳性预测值：63.2%，阴性预测值：100.0%）。确定IGFBP-2在TTS和ACS鉴别诊断中的最佳临界值为171.77ng/mL（敏感性：76.0%，特异性：82.6%，阳性预测值：76.4%，阴性预测值72.7%）。