Olatidoye A G, Wu A H, Feng Y J, Waters D
Department of Pathology and Laboratory Medicine Hartford Hospital, Connecticut, USA.
Am J Cardiol. 1998 Jun 15;81(12):1405-10. doi: 10.1016/s0002-9149(98)00200-8.
Controversy exists as to the clinical roles and relative specificities of cardiac troponin T or I in patients with unstable angina pectoris (UAP). We measured troponin T and I levels on admission in 123 patients with UAP. Of the 107 patients with normal creatine kinase during the first 24 hours, troponin T and I were elevated in 14 and 13 patients, respectively. At 30 days, 5 of 14 patients (36%) with elevated troponin T and 3 of 93 patients (3.2%) with normal troponin T had acute myocardial infarction (odds ratio [OR], 16.7; 95% confidence interval [CI] 3.4 to 81.5; p <0.001). Of 13 patients with elevated troponin I, 5 patients (39%) and 3 of 94 patients (3.2%) with normal troponin I had acute myocardial infarction (odds ratio, 21.7; 95% CI 4.3 to 110; p <0.001). No deaths occurred within 30 days. Both markers demonstrated equivalent sensitivity (63%) and specificities (troponin T: 91%; troponin I: 92%) for myocardial infarction. Meta-analysis of 12 published troponin T and 9 troponin I studies in patients with UAP produced risk ratios of 4.2 (95% CI 2.7 to 6.4, p <0.001) for troponin I compared with 2.7 (95% CI 2.1 to 3.4, p <0.001) for troponin T. Comparison of the sensitivities and specificities of both markers using summary receiver operating characteristic curves showed no significant difference in their abilities to predict acute myocardial infarction and cardiac death. Troponin T and I show similar prognostic significance for acute myocardial infarction or death in the same patients with UAP. The 2 markers are equally sensitive and specific, as confirmed by meta-analysis, and this supports a role in risk stratification.
关于心肌肌钙蛋白T或I在不稳定型心绞痛（UAP）患者中的临床作用及相对特异性存在争议。我们检测了123例UAP患者入院时的肌钙蛋白T和I水平。在最初24小时内肌酸激酶正常的107例患者中，分别有14例和13例肌钙蛋白T和I升高。30天时，肌钙蛋白T升高的14例患者中有5例（36%）发生急性心肌梗死，肌钙蛋白T正常的93例患者中有3例（3.2%）发生急性心肌梗死（比值比[OR]为16.7；95%置信区间[CI]为3.4至81.5；p<0.001）。在肌钙蛋白I升高的13例患者中，5例（39%）发生急性心肌梗死，肌钙蛋白I正常的94例患者中有3例（3.2%）发生急性心肌梗死（比值比为21.7；95%CI为4.3至110；p<0.001）。30天内无死亡发生。两种标志物对心肌梗死的敏感性（63%）和特异性（肌钙蛋白T：91%；肌钙蛋白I：92%）相当。对已发表的12项关于UAP患者肌钙蛋白T研究和9项肌钙蛋白I研究进行的荟萃分析显示，肌钙蛋白I的风险比为4.2（95%CI为2.7至6.4，p<0.001），而肌钙蛋白T的风险比为2.7（95%CI为2.1至3.4，p<0.001）。使用汇总的受试者工作特征曲线比较两种标志物的敏感性和特异性，结果显示它们在预测急性心肌梗死和心源性死亡方面的能力无显著差异。在同一UAP患者中，肌钙蛋白T和I对急性心肌梗死或死亡具有相似的预后意义。荟萃分析证实，这两种标志物具有同等的敏感性和特异性，这支持了它们在风险分层中的作用。
