Chaulin Aleksey Michailovich
Department of Histology and Embryology, Samara State Medical University, Samara 443099, Russia.
Department of Cardiology and Cardiovascular Surgery, Samara State Medical University, Samara 443099, Russia.
Life (Basel). 2023 Jan 18;13(2):267. doi: 10.3390/life13020267.
Cardiac troponins T and I are the main (most sensitive and specific) laboratory indicators of myocardial cell damage. A combination of laboratory signs of myocardial cell damage (elevated levels of cardiac troponins T and I) with clinical (severe chest pain spreading to the left side of the human body) and functional (rise or depression of the ST segment, negative T wave or emergence of the Q wave according to electrocardiography and/or decrease in the contractility of myocardial areas exposed to ischemia according to echocardiography) signs of myocardial ischemia is indicative of the ischemic damage to cardiomyocytes, which is characteristic of the development of acute coronary syndrome (ACS). Today, with early diagnostic algorithms for ACS, doctors rely on the threshold levels of cardiac troponins (99th percentile) and on the dynamic changes in the serum levels over several hours (one, two, or three) from the moment of admission to the emergency department. That said, some recently approved highly sensitive methods for determining troponins T and I show variations in 99th percentile reference levels, depending on gender. To date, there are conflicting data on the role of gender specificities in the serum levels of cardiac troponins T and I in the diagnostics of ACS, and the specific mechanisms for the formation of gender differences in the serum levels of cardiac troponins T and I are unknown. The purpose of this article is to analyze the role of gender specificities in cardiac troponins T and I in the diagnostics of ACS, and to suggest the most likely mechanisms for the formation of differences in the serum levels of cardiac troponins in men and women.
心肌肌钙蛋白T和I是心肌细胞损伤的主要（最敏感且特异）实验室指标。心肌细胞损伤的实验室指标（心肌肌钙蛋白T和I水平升高）与心肌缺血的临床（严重胸痛蔓延至身体左侧）和功能（根据心电图ST段抬高或压低、T波倒置或出现Q波，和/或根据超声心动图缺血心肌区域收缩力下降）征象相结合，提示心肌细胞发生缺血性损伤，这是急性冠状动脉综合征（ACS）发展的特征。如今，对于ACS的早期诊断算法，医生依赖于心肌肌钙蛋白的阈值水平（第99百分位数）以及从入院至急诊科起数小时（一、二或三小时）内血清水平的动态变化。话虽如此，一些最近获批的用于测定肌钙蛋白T和I的高灵敏度方法显示，第99百分位数参考水平存在性别差异。迄今为止，关于性别特异性在ACS诊断中对心肌肌钙蛋白T和I血清水平的作用，以及心肌肌钙蛋白T和I血清水平性别差异形成的具体机制尚无定论。本文旨在分析性别特异性在ACS诊断中对心肌肌钙蛋白T和I的作用，并提出男女血清中心肌肌钙蛋白水平差异形成的最可能机制。
