Gerhardt W, Ljungdahl L, Herbert A K
Clin Biochem. 1993 Aug;26(4):231-40. doi: 10.1016/0009-9120(93)90122-m.
We evaluated cardiac troponin T (S-troponin T) versus CK MB in serum (S-CK MB) sampled 4, 10, 16, and 22 h after onset of acute symptoms in 207 consecutive cases admitted to our coronary care unit in Helsingborg, Sweden, May-October 1992. These were primarily classified into 106 acute myocardial infarctions (AMI) and 101 NOT-AMI cases by conventional cardiological criteria plus S-CK MB (mass). Time curves of S-troponin T and S-CK MB data were plotted for each individual case. Twelve of the 101 cases in the NOT-AMI group showed increased S-troponin T indicating ischemic myocardial injuries. The same cases also showed changes of S-CK MB (mass), though below its discriminator. Seven of these cases were reclassified as minor myocardial damage, constituting 25% of our 28 cases of unstable angina. The remaining five cases showed a combination of constantly increased S-troponin T and decreasing or low S-CK MB mass values as seen after a recent infarction. Consequently, the patient material was reclassified into 118 cases of ischemic myocardial injury (106 conventional AMI + 7 minor myocardial damage + 5 postinfarctions) and 89 cases of NOT-ischemic myocardial injury. The frequency distributions of the maximal S-troponin T and S-CK MB (mass) values of each case were plotted in double test evaluation histograms. For troponin T, discriminator 0.20 micrograms/L, clinical sensitivity for ischemic myocardial injury was 97% and specificity 99%. With a lower discriminator of 0.10 micrograms/L, sensitivity increased to 99% and specificity decreased to 89%. For S-CK MB (mass), discriminator 10 micrograms/L, sensitivity was 91%, specificity 98%. With a lower discriminator of 5 micrograms/L sensitivity increased to 96% and specificity decreased to 78%. We conclude that as a single routine test, S-troponin T is the marker of choice for early diagnosis of ischemic myocardial damage. The combination S-troponin T and S-CK MB (mass) provides additional, detailed information in reinfarction and postinfarction unstable angina pectoris.
1992年5月至10月期间，我们对瑞典赫尔辛堡冠心病监护病房收治的207例连续病例进行了研究，评估急性症状发作后4、10、16和22小时采集的血清中心肌肌钙蛋白T（S-肌钙蛋白T）与血清肌酸激酶同工酶（S-CK MB）的情况。这些病例主要根据传统心脏病学标准及S-CK MB（质量）分为106例急性心肌梗死（AMI）和101例非AMI病例。为每个病例绘制了S-肌钙蛋白T和S-CK MB数据的时间曲线。非AMI组的101例病例中有12例显示S-肌钙蛋白T升高，提示存在缺血性心肌损伤。这些病例的S-CK MB（质量）也有变化，不过低于其鉴别值。其中7例病例被重新分类为轻度心肌损伤，占我们28例不稳定型心绞痛病例的25%。其余5例病例表现为S-肌钙蛋白T持续升高，同时S-CK MB质量值降低或处于低水平，这与近期心肌梗死后的情况相似。因此，将患者资料重新分类为118例缺血性心肌损伤（106例传统AMI + 7例轻度心肌损伤 + 5例心肌梗死后病例）和89例非缺血性心肌损伤。在双检测评估直方图中绘制了每个病例的最大S-肌钙蛋白T和S-CK MB（质量）值的频率分布。对于肌钙蛋白T，鉴别值为0.20微克/升时，缺血性心肌损伤的临床敏感性为97%，特异性为99%。鉴别值降低至0.10微克/升时，敏感性增至99%，特异性降至89%。对于S-CK MB（质量），鉴别值为10微克/升时，敏感性为91%，特异性为98%。鉴别值降低至5微克/升时，敏感性增至96%，特异性降至78%。我们得出结论，作为单一常规检测，S-肌钙蛋白T是早期诊断缺血性心肌损伤的首选标志物。S-肌钙蛋白T和S-CK MB（质量）联合检测可为再梗死和心肌梗死后不稳定型心绞痛提供额外的详细信息。
