Chaulin Aleksey Michailovich
Department of Cardiology and Cardiovascular Surgery, Samara State Medical University, Samara 443099, Russia.
Department of Histology and Embryology, Samara State Medical University, Samara 443099, Russia.
J Clin Med Res. 2022 Nov;14(11):448-457. doi: 10.14740/jocmr4796. Epub 2022 Nov 29.
It is well known that many pathological conditions of both cardiovascular diseases (CVDs) (coronary heart disease, myocardial infarction, arrhythmias, myocarditis, cardiomyopathy, etc.) and non-cardiac (sepsis, anemia, kidney diseases, diabetes mellitus, etc.) origin in the course of their development cause injury to contractile cardiac muscle cells - myocardial cells (MCs). One of the most sensitive and specific criteria for detecting MC injury are cardiospecific troponins (CTs), which are regulatory protein molecules that are released into the blood serum from MC upon their death or injury. Current methods for determining CTs are called high-sensitive ones, and their main advantage is a very low minimum detectable concentration (limit of detection) (average 1 - 10 ng/L or less), which allows early detection of minor MC injury at the earliest stages of CVDs, and therefore they can change the understanding of disease development mechanisms and open up new diagnostic possibilities. One of the most common and dangerous early diseases of the cardiovascular system is hypertension (HT). The novelty of this article lies in the discussion of a new diagnostic direction - predicting the risk of developing CVDs and their dangerous complications in patients with HT by determining the concentration of CTs. In addition, pathophysiological mechanisms underlying MC injury and the release of CTs into the bloodstream and the elimination of CTs into the urine are proposed. This information will contribute to additional fundamental and clinical research to verify the new diagnostic possibility of using CTs in clinical practice (for the management of patients with HT).
众所周知,许多心血管疾病(如冠心病、心肌梗死、心律失常、心肌炎、心肌病等)以及非心脏疾病(如败血症、贫血、肾脏疾病、糖尿病等)在其发展过程中,都会导致收缩性心肌细胞——心肌细胞(MCs)受损。检测MC损伤最敏感和特异的标准之一是心肌特异性肌钙蛋白(CTs),它是一种调节蛋白分子,在MC死亡或受损时会释放到血清中。目前测定CTs的方法被称为高灵敏度方法,其主要优点是最低可检测浓度(检测限)非常低(平均为1 - 10 ng/L或更低),这使得在心血管疾病的最早阶段就能早期检测到轻微的MC损伤,因此它们可以改变对疾病发展机制的认识,并开辟新的诊断可能性。心血管系统最常见和危险的早期疾病之一是高血压(HT)。本文的新颖之处在于讨论了一个新的诊断方向——通过测定CTs浓度来预测HT患者发生心血管疾病及其危险并发症的风险。此外,还提出了MC损伤以及CTs释放到血液中并排泄到尿液中的病理生理机制。这些信息将有助于开展更多的基础和临床研究,以验证在临床实践中使用CTs进行新诊断的可能性(用于HT患者的管理)。