Scheffold T, Zehelein J, Müller-Bardorff M, Katus H A
Medizinische Universitätsklinik, Heidelberg.
Z Kardiol. 1994;83 Suppl 6:75-82.
The measurement of cardiac enzymes is critical for the diagnosis of acute myocardial infarction. Cardiac enzymes, however, are by no means ideal marker molecules, primarily due to their non-specific tissue distribution and low concentration in cardiomyocytes. Many limitations of cardiac enzymes can be overcome by the measurement of cardiospecific troponin T or I with immunological techniques. In the evaluation of new diagnostic methods it is important to define the purpose of marker molecule measurement, i.e., monitoring of definite myocardial infarction or establishing the proper diagnosis in patients with suspected myocardial infarction. For monitoring of success of reperfusion therapy and for the detection of reocclusion short-lived perfusion markers with rapid appearance in circulation such as myoglobin, fatty acid binding protein or glycogenisophosphorylase BB are preferable. For proper diagnosis in patients with suspected acute myocardial infarction test systems with high sensitivity and specificity are needed due to the low prevalence of disease in the patients tested. Troponin T determinations are particularly useful in this group of patients. With troponin T determinations it could be shown that some patients so far classified as having unstable angina do in fact have microinfarction. These data indicate the need for re-definition of diagnostic criteria of acute myocardial infarction.
心脏酶的检测对于急性心肌梗死的诊断至关重要。然而，心脏酶绝非理想的标志物分子，主要是因为它们在组织中的分布不具有特异性，且在心肌细胞中的浓度较低。通过免疫技术检测心肌特异性肌钙蛋白T或I，可以克服心脏酶的许多局限性。在评估新的诊断方法时，明确标志物分子检测的目的很重要，即监测明确的心肌梗死或对疑似心肌梗死的患者进行准确诊断。对于监测再灌注治疗的效果以及检测再闭塞，循环中快速出现的短期灌注标志物如肌红蛋白、脂肪酸结合蛋白或糖原磷酸化酶BB更具优势。对于疑似急性心肌梗死的患者进行准确诊断时，由于受检患者中疾病的患病率较低，需要高灵敏度和特异性的检测系统。肌钙蛋白T检测在这类患者中特别有用。通过肌钙蛋白T检测发现，一些迄今被归类为不稳定型心绞痛的患者实际上存在微梗死。这些数据表明需要重新定义急性心肌梗死的诊断标准。
