需要更多的心肌肌钙蛋白临床应用研究

Troponin and acute coronary syndromes:more clinical studies needed

心肌肌钙蛋白(cTn)在急性冠状动脉综合征(ACS)的诊断和危险分层等方面的重要作用已经得到了普遍认同。大量的临床资料表明,cTn 增高的 ACS 患者属于高危险性,在今后一段时间内出现心脏事件(心肌梗死等)的临床可能性大大增加。临床应用时应注意选取合适的判断值(例如:参考范围上限的第99百分位值);应了解究竟选取 cTn 检测 CV≤10%的最低检测值作为临界值还是根据操作者工作特性曲线(ROC 曲线)选取临界值;应注意不同的 cTnI 检测系统检测值存在差异这一现象。

Monitoring cardiac troponin I （ cTnI ） or T （cTnT） for the detection of myocardial injury and for risk stratification in acute coronary syndromes （ACS） has been endorsed by the laboratory medicine community （IFCC, AACC, NACB ） and the cardiology community （ESC and ACC ）. The clinical laboratories has long been argued on the best cut-point values for troponin assay-some believe it should be set at the 99m percentile of the reference population, while others believe it should be at the level where the particular assay＇s coefficient of variation （CV） is less than 10%, with the 10% CV varying by test manufacturer. Besides, there are numerous cTnI measurement systems, confusion regarding cTnI measurements has resulted large variability demonstrated among the cTnI assays. The aim of this opinion is to reflect on some concepts related to using cTn in clinical practice.