高敏心肌肌钙蛋白Ⅰ水平变化对急性非ST段抬高型心肌梗死的诊断价值分析

目的 探讨高敏心肌肌钙蛋白Ⅰ(hs-cTnI)在急性非ST段抬高型心肌梗死(NSTEMI)中的诊断价值.方法 回顾性分析2018年1月至2020年10月以胸痛为主诉就诊于该院急诊科的疑似非ST段抬高型急性冠脉综合征(NSTE-ACS)患者资料.采用纯态氧介导化学发光法检测患者在就诊时(T0)及就诊3 h(T3)的血浆h...     

急性冠脉综合征患者的NT-proBNP和心肌肌钙蛋白之间的关系

目的探析急性冠脉综合征患者的NT-proBNP(氨基末端脑钠肽前体)和心肌肌钙蛋白的相关性。方法选取我院于2017年1月～2018年2月收治的49例急性冠脉综合征患者作为主要研究对象,依据临床诊断结果将其分为ST段抬高急性心肌梗死组(20例)、非ST段抬高急性心肌梗死组(16例)、不稳定型心绞痛组(13例),并选取同期于我院接受健康检查的15例健康人作为对照组,测定四组研究对象的NT-proBNP、心肌肌钙蛋白,并对三组的NT-proBNP和心肌肌钙蛋白进行比较。结果 ST段抬高急性心肌梗死组的NT-proBNP明显高于非ST段抬高急性心肌梗死组、不稳定型心绞痛组和对照组,四组比较,差异有统计学意义(P0.05);ST段抬高急性心肌梗死组的肌钙T明显高于非ST段抬高急性心肌梗死组、不稳定型心绞痛组和对照组,四组比较差异有统计学意义(P0.05);急性冠脉综合征患者的NT-proBNP与c Tn呈正相关。结论 ST段抬高急性心肌梗死患者的NT-proBNP和肌钙T水平较高,可以作为反应急性冠脉综合征患者病情严重程度的心肌标志物,可以为疾病进展提供科学依据,值得进一步推广应用。     

高敏肌钙蛋白在非ST段抬高急性冠状动脉综合征诊断中的临床应用

目的探讨高敏肌钙蛋白在非ST段抬高急性冠状动脉综合征诊断中的临床应用价值。方法选取2012年10月—2013年12月期间在我院住院的非ST段抬高急性冠状动脉综合征(NSTE-ACS)患者127例,其中非ST段抬高型心肌梗死患者62例,不稳定型心绞痛患者65例,入院时采集患者外周静脉血测定高敏感性肌钙蛋白hs-cTn、hs-cTnI。结果非ST段抬高型心肌梗死组患者的hs-cTnT、hs-cTnI水平均比不稳定型心绞痛组高(P0.05)。hscTnT106pg/ml、hs-cTnI62pg/ml是诊断非ST段抬高型心肌梗死的最佳诊断界值,且诊断灵敏性、特异性相似。结论高敏肌钙蛋白对NSTE-ACS具有重要的诊断价值,早期筛检有利于对NSTE-ACS患者进行临床对症治疗。     

非ST段抬高急性冠状动脉综合征患者血浆心肌肌钙蛋白T的变化及意义

本研究采用Roche公司Elecsys2010电化学发光系统，检测200例非ST段抬高急性冠状动脉综合征（NSTEACS）患者血浆心肌肌钙蛋白T（cTnT）含量，并初步探讨cTnT在非ST段抬高心肌梗死（NSTEMI）中的意义、变化及其在NSTEACS危险分层中的意义。     

高敏心肌肌钙蛋白在非ST段抬高型心肌梗死早期心肌损伤诊断中的临床应用

目的:探讨高敏心肌肌钙蛋白T(hs-cTnT)在对非ST段抬高心肌梗死心肌损伤早期的临床诊断价值。方法:检测242例急症胸痛患者(最终确诊为非ST段抬高心肌梗死54例患者),分别于胸痛发作2、2.5、3、3.5、4、4.5、5、6 h采静脉血进行hs-cTnT、普通肌钙蛋白T(cTnT)检测。结果:针对非ST段抬高心肌梗死患者两组数据比较:hs-cTnT组在胸痛2 h即可出现异常升高者;而测定cTnT在胸痛2～2.5 h期间未出现阳性标本,胸痛3～4 h才少部分异常升高,两组之间在2～4 h的时间段内差异存在显著性(P<0.01);hs-cTnT组在胸痛<4 h的敏感度和特异性为87.0%和86.5%,cTnT组的分别为72.2%和89.6%。结论:hs-cTnT与cTnT相比,该检测方法可在胸痛2～4 h内检出更多的非ST段抬高心肌梗死患者,且更加利于心肌损伤的早期诊断。     

心肌肌钙蛋白的研究进展

作为检测心肌细胞损伤的一项灵敏而特异的指标,心肌肌钙蛋白(cardiac troponin,cTn)是目前诊断心肌损伤尤其是AMI的重要生物学标志物。近年来,随着检测技术的迅速发展,cTn分析性能大大提高,已广泛用于心肌缺血检测,AMI早期诊断,不良心脏事件预测,急性冠脉综合征危险分层,治疗药物监测,普通人群结构性心脏疾病、死亡风险判断,老年人群心力衰竭及心血管事件死亡风险相关性分析,老年心力衰竭患者预后预测及血透析患者预后判断等。尽管cTn的检测与临床应用方面仍有许多问题需待解决,但随着cTn检测能力、分析性能的提高及病理生理机制的深入研究,这将有助于改善临床患者的诊断、治疗和预后。     

高敏肌钙蛋白检测在非ST段抬高急性冠状动脉综合征诊断中的价值

急性冠脉综合征包括急性心肌梗死、不稳定性心绞痛。而非ST段抬高急性冠脉综合征包括不稳定型心绞痛和非ST段抬高型心肌梗死,上述两种在临床表现有所差异,治疗措施也有较多差别。不稳定型心绞痛和非ST段抬高型心肌梗死的鉴别诊、断,有助于临床实施正确治疗措施。本文选择我院不稳定型心绞痛和非ST段抬高型心肌梗死患者,观察高敏肌钙蛋白在其中的诊断作用。     

HEART评分联合NT-proBNP对非ST段抬高型急性冠脉综合征患者心血管不良事件的预测价值

目的探讨HEART评分联合N端脑钠肽前体(N-terminal pro-B-type natriuretic peptides, NT-proBNP)对非ST段抬高型急性冠脉综合征(non-ST-elevatio acute coronary syndrome, NSTE-ACS)患者3个月心血管不良事件(major adverse cardiovascular events, MACE)的风险预测价值。方法本研究为回顾性研究, 纳入2018年1月至2018年3月期间在中山大学附属第五医院就诊的符合NSTE-ACS诊断标准的成年急性胸痛患者, 排除NSTE-ACS以外导致的心源性胸痛、非心源性胸痛、肾功能不全、急性脑梗死、终末期疾病、妊娠、资料不完整的患者。记录患者的临床资料、首次心电图、肌钙蛋白I(cardiac troponin I, cTnI)和NT-proBNP结果。分析NT-proBNP水平与3个月内发生MACE的关系, 绘制受试者工作特征曲线(receiver operating characteristic, ROC)分析对比NT-proBNP水平、HEART评分及两者联...     

心肌肌钙蛋白I在急性冠状动脉综合征中的临床应用

目的探讨心肌肌钙蛋白I(cTn-I)在急性冠状动脉综合征(ACS)危险度分层中的临床应用。方法选择急性心肌梗死(AMI)患者组58例,不稳定型心绞痛患者组46例,非ST抬高的心肌梗死(NSTEMI)患者组35例,ST抬高的心肌梗死(STEMI)患者组35例;健康对照组26例。采用化学发光免疫分析技术定量检测心肌cTn-I。结果急性心肌梗死组、不稳定型心绞痛组患者、非ST抬高的心肌梗死组患者、ST抬高的心肌梗死组患者心肌cTn-I的含量明显高于健康对照组(P<0.01),急性心肌梗死组、不稳定型心绞痛组患者、非ST抬高的心肌梗死组患者、ST抬高的心肌梗死组患者之间心肌cTn-I的含量比较亦有差异(P<0.05)。结论心肌cTn-I在急性冠状动脉综合征时可升高,是诊断心肌损伤的敏感指标。     

心肌肌钙蛋白Ⅰ在急性冠状动脉综合征中的临床应用

目的 探讨心肌肌钙蛋白Ⅰ(cTn-Ⅰ)在急性冠状动脉综合征(ACS)危险度分层中的临床应用.方法 选择急性心肌梗死(AMI)患者组58例,不稳定型心绞痛患者组46例,非ST抬高的心肌梗死(NSTEMI)患者组35例,ST抬高的心肌梗死(STEMI)患者组35例;健康对照组26例.采用化学发光免疫分析技术定量检测心肌cTn-Ⅰ.结果 急性心肌梗死组、不稳定型心绞痛组患者、非ST抬高的心肌梗死组患者、ST抬高的心肌梗死组患者心肌cTn-Ⅰ的含量明显高于健康对照组(P＜0.01),急性心肌梗死组、不稳定型心绞痛组患者、非ST抬高的心肌梗死组患者、ST抬高的心肌梗死组患者之间心肌cTn-Ⅰ的含量比较亦有差异(P＜0.05).结论 心肌cTn-Ⅰ在急性冠状动脉综合征时可升高,是诊断心肌损伤的敏感指标.     

Risk stratification of chest pain patients by point-of-care cardiac troponin T and myoglobin measured in the emergency department

A prospective multicenter study including 1410 chest pain patients with suspected acute coronary syndromes was carried out to examine the predictive value of biological cardiac markers for adverse events measured by a point-of-care system. Admission cardiac troponin T (cTnT) and myoglobin were measured in parallel on a point-of-care system in the emergency department and -- together with CK-MB mass -- on lab analyzers. In a one-year follow-up, cardiac and non-cardiac death, acute myocardial infarction, unstable angina pectoris and need for revascularization were registered. Median time between onset of symptoms and admission was 285 min; 172 patients (12.2%) had no event during follow-up. If the cTnT, measured either by the point-of-care system or a conventional lab analyzer, was >0.05 microg/L, then the chance of a cardiac event during the follow-up period was doubled (18% vs. 9%). Serial cTnT measurement did not add any further value to the predictive power of the admission cTnT. Myoglobin and CK-MB mass identified increasing risk with increasing concentration quartiles; cardiac event rates were 2.8- to 4.4-fold higher between the quartiles with the lowest and those with the highest analyte concentration, respectively. There was no difference in non-cardiac death rates between any concentration quartiles. In conclusion, the prediction of clinical events by cardiac troponin T and myoglobin measured with a point-of-care analyzer in the emergency department was as good as that of the same cardiac markers and CK-MB mass measured on lab analyzers.     

Prognostic value of serum concentration of heart-type fatty acid-binding protein relative to cardiac troponin T on admission in the early hours of acute coronary syndrome

BACKGROUND: Heart-type fatty acid-binding protein (H-FABP) is proposed as an early biomarker for acute myocardial infarction (AMI), but its prognostic value is unclear in acute coronary syndrome (ACS). We evaluated the prognostic value of the H-FABP concentration relative to cardiac troponin T (cTnT) in the early hours of ACS. METHODS: Serum concentrations of H-FABP and cTnT were measured on admission in 328 consecutive patients hospitalized for ACS within 6 h after the onset of chest pain [AMI, 241 (73.5%) patients; ST-segment elevation myocardial infarction, 154 (47.0%) patients; and emergent coronary angiography within 24 h after admission, 287 (87.5%) patients]. Cardiac events, which were defined as cardiac death or subsequent nonfatal AMI, were monitored for 6 months after admission. RESULTS: During the 6-month follow-up period, there were 25 cardiac events, including 15 cardiac deaths and 10 subsequent nonfatal AMIs. Stepwise multivariate analyses including clinical, electrocardiographic, and biochemical variables revealed that increased H-FABP (above the median of 9.8 microg/L), but not increased cTnT (above the median of 0.02 microg/L), was independently associated with cardiac events in all patients [relative risk (RR) = 8.96; P = 0.0004], the subgroup of patients with ST-segment elevation myocardial infarction (RR = 11.3; P = 0.02), and the subgroup of patients with unstable angina and non-ST-segment elevation myocardial infarction (RR = 8.31; P = 0.007). The area under the ROC curve was higher for H-FABP than for cTnT (0.711 vs 0.578; P = 0.08), suggesting that H-FABP concentrations have a greater predictive capacity for cardiac events than cTnT. CONCLUSION: Serum H-FABP is a potential independent predictor of cardiac events within 6 months of patient admission and may provide prognostic information superior to cTnT in the early hours of ACS.     

高敏肌钙蛋白I在不稳定型心绞痛严重程度及预后评估中的应用

目的 探讨高敏肌钙蛋白I(hs-cTnI)检测在不稳定型心绞痛(UAP)患者的诊断、冠状动脉病变严重程度及短期预后判断等方面中的应用.方法 102例常规血清cTnI阴性的UAP患者,冠状动脉造影前测定血清hs-cTnI水平,随访30 d,记录心血管不良事件.结果 hs-cTnI水平随着冠脉病变的严重程度而升高,hs-cTnI水平越高,冠脉狭窄程度及病变累及血管的程度越严重,差异有统计学意义(P＜0.05).hs-cTnI升高组主要心血管事件发生率明显高于hs-cTnI正常组,差异有统计学意义(P＜0.01).结论 hs-cTnI水平的高低可预测冠脉病变的狭窄严重程度与病变范围,其升高提示短期预后不佳、主要心血管事件发生率增加,可作为UAP早期危险分层的一个指标.     

心肌肌钙蛋白T检测对维持性血透尿毒症患者心血管事件发生的临床意义

目的 探讨检测心肌肌钙蛋白T(cTnT)对维持性血透的尿毒症患者心血管事件发生的临床意义.方法 测定136例维持性血透尿毒症患者透析前、后的cTnT,每6个月测定cTnT 1次,随访3年,观察患者心血管事件及死亡事件发生情况,分析其与cTnT的关系.同时测定100名健康体检者的cTnT,并作对比分析.结果 维持性血透尿...     

Analytical and diagnostic performance of troponin assays in patients suspicious for acute coronary syndromes

BACKGROUND: The controversy whether there is a clinically significant difference between troponin T (cTnT) and troponin I (cTnI) in regard to predictive value and cardiac specificity is still ongoing. METHODS: We evaluated enzyme-linked immunosorbent assay systems for cTnI and cTnT in patients with acute coronary syndromes and multiple control groups to define threshold values for risk stratification and compare their predictive value. RESULTS: In 312 patients with noncardiac chest pain, cTnI levels were below the detection limit of 0.2 microg/L and cTnT levels were 0.011 [0.010-0. 013] microg/L. In patients with end-stage renal failure (n = 26) and acute (n = 38) or chronic (n = 16) skeletal muscle damage, median concentrations were 0.20 [0.20-0.35], below the detection limit, and 0.20 [0.20-0.25] for cTnI, and 0.04 [0.01-0.10], 0.011 [0.005-0.025], and 0.032 [0.009-0.054] microg/L for cTnT. In patients with acute coronary syndromes (n = 1130), maximized prognostic value for 30-day outcome (death, infarction) was observed at a threshold level of 1.0 microg/L for cTnI (29.0% positive) and at 0.06 microg/L for cTnT (35. 0% positive). Significant differences in the area-under-the-curve values were observed between cTnI and cTnT (0.685 vs. 0.802; p = 0. 005). For both markers, the area-under-the-curve values did not increase with the second (within 24 h after enrollment) or third (48 h) blood draw. CTnI showed a less strong association with 30-day outcome than cTnT. When cTnI was put in a logistic multiple-regression model first, cTnT did add significant information. CONCLUSION: By using the defined threshold values and the employed test systems, single testing for cTnI and cTnT within 12 h after symptom onset was appropriate for risk stratification. Despite the lower cardiac specificity for cTnT, it appears to have a stronger association with the patients' outcome, whereas, as previously shown, the ability to identify patients who benefit from treatment with a GP IIb/IIIa receptor antagonist is similar.     

血清肌钙蛋白Ⅰ对充血性心力衰竭预后的影响

目的 现察慢性充血性心力衰竭患者不同血清肌钙蛋白Ⅰ(cTnI)浓度与1年病死率的关系.方法 入选2008年1～12月在我院心内科住院的诊断为慢性充血性心力衰竭患者225例,根据住院测定的cTnI浓度将患者分为正常组与异常组,异常组再分为轻度增高组、中度增高组、增高组,记录其住院期间及随访1年发生的心脏性事件.结果 225例患者随访1年发生心脏性事件58例(25.8%),异常组病死率依次高于正常组(60.0%>40.8%>24.0%>18.4%,P<0.01).logistic回归分析显示,cTnI为慢性充血性心力衰竭预后不良的相关因素.结论 cTnI增高是随访1年发生心脏性事件的危险因素(P<0.05),是死亡的预测因子.血清cTnI>0.10 μg/L的慢性充血性心力衰竭患者为高危人群.     

缺血修饰白蛋白在急性心肌缺血早期诊断中的临床价值

目的 探讨血清缺血修饰白蛋白（ischemiamodifiedalbumin,IMA）检测在急性心肌缺血早期诊断中的临床价值。方法收集80例急性冠状动脉综合征（acutecoronarysyndrome,ACS）患者及60例确诊为非缺血性心脏病患者,采用间接白蛋白钴结合试验（albumincobaltbindingtest,ACB）检测受试者胸痛发作3h内的血清IMA水平,同时检测患者心肌肌钙蛋白T（cardiactroponinT,cTnT）、肌酸激酶同工酶（creatinekinaseisoenzymeMB,CK—MB）水平。通过受试者工作特征（receiveroperatingcharacter—istic．ROC）曲线判定IMA用于诊断ACS的最佳临界值,确定IMA诊断ACS的敏感度、特异性、阳性预测值和阴性预测值。结果与对照组比较,ACS组ACB值明显降低,且两组间比较差异具有统计学意义（P〈0．01）,而两组间cTnT、CK—MB水平差异均无统计学意义（P均〉0．05）。急性心肌梗死组与不稳定型心绞痛组间ACB值比较差异无统计学意义（P〉0．05）。根据ROC曲线,当cut—off值为63．60U／mL时,IMA检测ACS的敏感度、特异性、阳性预测值和阴性预测值均较高,分别为81．27％、86．58％、84．19％和82．57％。结论IMA是早期诊断心肌缺血的敏感标志物．对于ACS的早期诊断和治疗具有重要的临床意义。     

入院高血糖对急性冠状动脉综合征预后影响的探讨

目的 初步探讨入院高血糖对急性冠状动脉综合征(ACS)预后相关因素的影响.方法 109例ACS患者按血糖>7.8 mmol/L分为A组(n=68例),血糖≤7.8 mmol/L为B组(n=41例),比较两组临床情况和住院期间不良事件发生情况.以基线指标为自变量,以住院期间心血管事件发生率为因变量进行单因素分析和多元回归分析,探讨住院期间对心血管事件有显著性影响的危险因素.结果 A组的心率、肌酐(Cr)、肌酸激酶同工酶(CK-MB)和肌钙蛋白I(cTnI)均高于B组,心率(116.9±10.8)次/min vs(105.1±21.2)次/min、Cr(142.0±8.9)μmol/L vs(109.0±10.1)μmol/L,CK-MB(0.38±0.01)μg/L vs(0.27±0.00)μg/L,cTnI(189.0±10.5)μg/L vs(86.0±9.8)μg/L(均P<0.01);两组心血管事件,包括心力衰竭(29.4%vs 26.8%)、心源性休克(4.4%vs 4.9%)、心律失常发生率(22.1%vs 34.1%)近期死亡发生率(2.9%vs 2.4%),差异无统计学意义(P>0.05);多元回归分析显示,心率、肌酐和血糖升高是住院期间心血管事件发生的危险因素.结论 入院血糖水平升高是ACS患者风险发生的标志.为制定ACS患者强化血糖控制的安全性、可行性和有效性提供了参考.     

Interaction between heparin and cardiac troponin T and troponin I from patients after coronary bypass surgery

OBJECTIVES: Heparin is thought to play a crucial role in the clinical monitoring of patients with acute coronary syndrome as well as after coronary bypass surgery in that it interferes with different commercial immunoassay test systems for cardiac troponin T (cTnT) and troponin I (cTnI). The mechanism, however, by which heparin apparently affects the cTnT and cTnI levels in plasma is not yet resolved. DESIGN AND METHODS: We analyzed the effect of heparin by simultaneously collecting serum and heparin plasma samples from 32 patients after coronary bypass surgery. The cTnT and cTnI levels were determined using the Roche/Elecsys, the Dade-Behring/Opus and the Bayer/ACS:Centaur immunoassay systems in the absence or in the presence of either heparinase or protamine. Association between the cardiac troponins and the anticoagulant has been demonstrated by affinity chromatography using heparin as the ligand. RESULTS: The data obtained indicate that heparin produces an apparent decrease in cTnT as well as of cTnI levels, analyzed either by the Elecsys, the Opus or the ACS:Centaur immunoassay systems. Individual patients show a wide variation in the discrepancies between serum and heparin plasma troponin especially in the cTnT immunoassay. Pretreatment of the heparin plasma samples either with heparinase or protamine cannot completely reverse the heparin-induced decrease in cTnT and cTnI levels and therefore addition of these reagents to the commercial test systems could not significantly improve the performance of the assay. When serum is supplemented with increasing concentrations of heparin, and cardiac troponin levels were reanalysed, significantly lower recoveries for the cTnT than for the cTnI immunoassays were detectable. Affinity chromatography with heparin Sepharose demonstrates that cTnT and cTnI interact differentially with the negatively charged ligand. Whereas cTnI shows minor affinity to the immobilized heparin and is eluted at near physiological conditions, cTnT is bound and can be quantitatively recovered only by solutions of high ionic strength. CONCLUSIONS: We conclude, therefore, that the apparent decrease in cTnT values by addition of heparin is a result of direct molecular interaction between the negatively charged glycosaminoglycan and clusters of basic residues within the sequence of the cardiac protein. In contrast, the effect of heparin on the cTnI immunoassay systems, is primarily indirect, most possibly induced by changes within the sample matrix itself.     

肌钙蛋白I和T测定对急性心肌梗塞的诊断意义

目的探讨肌钙蛋白I（cTnI）和肌钙蛋白T（cTnT）测定对急性心肌梗塞（AMI）的诊断价值。方法对52例AMI患者采用免疫层析法进行检测cTnI和cTnT,以对照区和检测区均有显色带者为阳性,并作灵敏度和特异性的比较。结果以胸痛0～3h、4～6h两个时段观察其灵敏度,cTnI为56.7%和96.1%;cT-nT为50.0%和92.3%。特异性cTnI为100%和96.2%;cTnT为100%和91.6%。cTnI灵敏度高于cTnT,特异性cTnI与cTnT之间无显著性差异。结论对AMI急性胸痛患者可同时进行cTnI和cTnT检测,有利于AMI的诊断和治疗。