规范应用心肌肌钙蛋白和利钠肽现场快速检测专家共识(2020年)

2020 Chinese Expert Consensus Statement on Point-of-Care Testing of Cardiac Troponin and Natriuretic Peptide

国内外多部指南建议使用心肌肌钙蛋白(cTn)和B型利钠肽(BNP)/N末端B型利钠肽原(NT-proBNP)用于急性冠状动脉综合征(ACS)和急、慢性心力衰竭的诊断、鉴别诊断和危险分层,以指导相关治疗。鉴于胸痛和胸痛等同症状以及胸闷(呼吸困难)是心血管病患者常见症状,而现场快速检测(point-of-care testing,POCT)具有仪器小型化、操作简单化、结果报告即时化(2~10 min内提供结果)、不受时间与地点限制等优势,本共识优先推荐特异度和灵敏度都较好的POCT技术检测cTn和BNP/NT-proBNP分别作为怀疑ACS和心力衰竭患者在适宜临床情况下的初诊检测项目。但POCT在快速获得测试结果、检验周转时间短的情况下,可能会牺牲部分结果的准确性,还存在医生不规范使用POCT和解读检测结果以及质量控制与管理等影响结果准确性的因素,甚至有可能导致错误的临床决策,因此对POCT也需要加强质量管理。为规范POCT技术检测cTn和BNP/NT-proBNP在临床的应用,特编写该共识。

Cardiac troponin(cTn)and B-type natriuretic peptide(BNP)/N-terminal proBNP(NT-proBNP)were recommended by domestic/foreign guidelines for diagnosis,differential diagnosis and risk stratification of acute coronary syndrome(ACS)and acute/chronic heart failure.Considering that chest pain(or equivalent symptoms)and dyspnea are common symptoms of cardiovascular disease patients,point-of-care testing(POCT)have the advantages of miniaturization,simplified operation,real-time results reporting(within 2-10 minutes),and are not restricted by time and place.This consensus give priority to recommend POCT techniques with good specificity and sensitivity to detect cTn and BNP/NT-proBNP as initial diagnosis test items for patients with suspected ACS and heart failure under appropriate clinical conditions.However,POCT may sacrifice the accuracy of some results when the test results can be obtained quickly and the test turnaround time can be saved.Some factors can affect the accuracy of the results such as lack of standardization of POCT testing,misinterpretation of the results,poor quality control and management etc.,thus may lead to incorrect clinical decisions.Therefore,the quality management of POCT need to be strengthened.In order to standardize the clinical application of POCT technology to detect cTn and BNP/NT-proBNP,this consensus is specially compiled.