COPD急性加重期患者外周血单个核细胞SOCS-1、TLR4 mRNA及血清cTnT、尿酸水平变化分析

目的探讨慢性阻塞性肺疾病(COPD)急性加重期患者外周血单个核细胞中细胞因子信号抑制蛋白-1(SOCS-1)、Toll样受体4(TLR4)mRNA水平及血清心肌肌钙蛋白T(cTnT)、尿酸水平变化。方法收集COPD急性加重期(组)患者70例,COPD稳定期(组)患者40例,对照组健康志愿者40名。检测外周血单个核细胞SOCS-1、TLR4 mRNA水平及血清cTnT、尿酸浓度;行肺功能检查并记录相关指标(FEV1、FEV1%、FEV1/FVC%)。对COPD急性加重期患者进行1 a随访,分为预后不良组和预后良好组。对外周血单个核细胞SOCS-1、TLR4 mRNA水平、血清cTnT、尿酸浓度行Pearson相关性分析,并对COPD急性加重期患者预后评估价值进行ROC曲线分析。结果COPD急性加重期组SOCS-1 mRNA表达水平明显低于COPD稳定期组、对照组,TLR4 mRNA水平及血清cTnT、尿酸浓度明显高于COPD稳定期组和对照组(均P<0.01)。COPD急性加重期组FEV1、FEV1%、FEV1/FVC%明显低于COPD稳定期组和对照组(P<0.05)。COPD急性加重期患者FEV1/FVC%与外周血单个核细胞SOCS-1 mRNA表达水平呈正相关关系(P<0.01),与外周血单个核细胞TLR4 mRNA水平及血清cTnT、尿酸浓度呈负相关关系(P<0.01)。预后不良组SOCS-1 mRNA水平明显低于预后良好组,TLR4 mRNA水平及血清cTnT、尿酸浓度明显高于预后良好组(P<0.05)。外周血单个核细胞SOCS-1、TLR4 mRNA水平及血清cTnT、尿酸联合检测对COPD急性加重期患者预后具有较高的评估价值。结论COPD急性加重期患者SOCS-1低表达,TLR4、cTnT、尿酸高表达,且与肺功能水平密切相关,联合检测对患者预后具有较高的评估价值。

血清cTnT、NT-proBNP峰值评估急性心肌梗死后梗死面积及1年不良预后的临床价值

目的探讨肌钙蛋白T(cTnT)峰值联合氨基末端B型利钠肽前体(NT-proBNP)峰值评估急性心肌梗死(AMI)后梗死面积(IS)及1年不良事件的临床价值。方法回顾性分析2016年1月至2021年7月于上海市静安区中心医院就诊的AMI患者150例。每日检测cTnT及NT-proBNP至峰值出现,心脏磁共振评估IS,随访1年不良事件。logistic回归分析IS及不良事件发生的风险因素,ROC曲线分析cTnT、NTproBNP峰值的预后价值。结果共纳入49例患者,根据不良事件发生分为事件组(n=19)和无事件组(n=30),根据中位IS值分为IS≥18.26%组(n=25)和<18.26%组(n=24)。事件组IS、cTnT、NT-proBNP明显高于无事件组,差异有统计学意义(P<0.05)。IS≥18.26%组cTnT、NT-proBNP显著高于IS<18.26%组,不良事件发生有统计学意义(P<0.05)。ROC曲线显示cTnT峰值联合NT-proBNP峰值预测AMI预后效果最好,AUC为0.935,两指标联合预测IS的AUC为0.883。结论血清cTnT、NT-proBNP峰值能反映AMI心肌IS大小,具预后价值,两者联合效果更优。

Prognostic value of N-terminal pro B-type natriuretic peptide and troponin Ⅰ in children with dengue shock syndrome

Objective:To investigate the contribution of N-terminal pro B-type natriuretic peptide(NT-pro BNP)and troponin Ⅰ to mortality in children with dengue shock syndrome.Methods:A longitudinal study was conducted on children with dengue shock syndrome in a hospital in southern Vietnam.Detailed clinical histories,physical examinations,and laboratory parameters,including NT-pro BNP and troponin Ⅰ,were recorded.A comparison between survival and non-survival was carried out to identify factors influencing mortality.Results:A total of 107 patients with a median age of 9 years were included in the study.Among them,63.6%(68/107)presented with compensated shock,36.4%(39/107)had hypotensive shock,23.4%(25/107)required mechanical ventilation,and 12.1%(13/107)died.The NT-pro BNP levels were 3.9 pmol/L(IQR:1.9,10.3)and 15.2 pmol/L(5.8,46.3),while the median high sensitivity troponin Ⅰ levels were 20 pg/L(6,95)and 62 pg/L(12,325)at the first and second measurements,respectively.The mortality group exhibited higher rates of hypotensive shock,prolonged shock,lactate levels,liver damage,NT-pro BNP,and troponin Ⅰ levels.Hypotensive shock(OR 12.96,95%CI 2.70-62.30,P=0.004),prolonged shock(OR 39.40,95%CI 6.68-232.70,P<0.001),AST>1000 IU/L(OR 9.50,95%CI 2.63-34.34,P=0.041),and NT-pro BNP>7 pmol/L(OR 44.40,95%CI 5.44-362.20,P=0.001)were identified as predictive factors for mortality in dengue shock syndrome.Conclusions:The NT-pro BNP level could serve as a potential biomarker for predicting mortality in children with dengue shock syndrome.

血清BNP、hs-CRP、UA与cTnT联合检测对心力衰竭的诊断价值研究

目的分析血清B型钠尿肽(BNP)、超敏C反应蛋白(hs-CRP)、尿酸(UA)、心肌肌钙蛋白T(cTnT)联合检测对心力衰竭(HF)的诊断价值。方法回顾性分析103例HF患者的资料并将其作为研究组,另回顾性分析体检的98例健康者的资料并将其作为对照组。两组研究对象均接受血清BNP、hs-CRP、UA与cTnT检测。比较两组研究对象血清BNP、hs-CRP、UA与cTnT水平;比较美国纽约心脏病学会(NYHA)分级Ⅰ~Ⅱ级、Ⅲ~Ⅳ级HF患者的血清BNP、hs-CRP、UA与cTnT水平;比较单独血清BNP、hs-CRP、UA、cTnT检测与四项指标联合检测对HF的检出率。结果研究组血清BNP、hs-CRP、UA、cTnT分别为(290.95±45.68)pg/ml、(5.12±1.02)mg/L、(432.26±30.58)μmol/L、(17.03±3.52)pg/ml,均高于对照组的(47.56±15.00)pg/ml、(1.36±0.46)mg/L、(285.65±35.44)μmol/L、(6.45±2.02)pg/ml(P<0.05)。NYHA分级Ⅲ~Ⅳ级HF患者血清BNP、hs-CRP、UA、cTnT分别为(336.52±50.66)pg/ml、(6.02±0.98)mg/L、(460.46±40.49)μmol/L、(19.56±3.00)pg/ml,均高于Ⅰ~Ⅱ级患者的(236.65±45.88)pg/ml、(4.05±1.00)mg/L、(398.65±35.45)μmol/L、(14.02±3.02)pg/ml(P<0.05)。血清四项指标联合检测对HF的检出率88.35%高于单独血清BNP、hs-CRP、UA、cTnT检测的72.82%、67.96%、60.19%、56.31%(P<0.05)。结论血清BNP、hs-CRP、UA与c TnT水平联合检测可以有效提高HF的检出率,具有临床应用价值。

High-sensitivity cardiac troponins in everyday clinical practice

High-sensitivity cardiac troponin(hs-cTn) assays are increasingly being used in many countries worldwide,however,a generally accepted definition of high-sen-sitivity is still pending.These assays enable cTn mea-surement with a high degree of analytical sensitivity with a low analytical imprecision at the low measuring range of cTn assays(coefficient of variation of < 10% at the 99th percentile upper reference limit).One of the most important advantages of these new assays is that they allow novel,more rapid approaches to rule in or rule out acute coronary syndromes(ACSs) than with previous cTn assay generations which are still more commonly used in practice worldwide.hs-cTn is also more sensitive for the detection of myocardial damage unrelated to acute myocardial ischemia.Therefore,the increase in early diagnostic sensitivity of hs-cTn assays for ACS comes at the cost of a reduced ACS specificity,because more patients with other causes of acute or chronic myocardial injury without overt myocardial isch-emia are detected than with previous cTn assays.As hs-cTn assays are increasingly being adopted in clinical practice and more hs-cTn assays are being developed,this review attempts to synthesize the available clinical data to make recommendations for their everyday clini-cal routine use.

Comparison of plasma microRNA-1 and cardiac troponin T in early diagnosis of patients with acute myocardial infarction

BACKGROUND:Early reperfusion can effectively treat acute myocardial infarction(AMI) and reduce the mortality signif icantly. This study aimed to compare the role of plasma microRNA-1(miR-1) and cardiac troponin T(cTnT) in early diagnosis of AMI patients.METHODS:From May 2011 to May 2012,plasma samples were collected from 56 AMI patients and 28 non-AMI controls. The expression of plasma miR-1 was measured by quantitative reverse transcription-polymerase chain reaction(qRT-PCR),and the level of plasma cTnT was measured using electrochemiluminescence-based methods on an Elecsys 2010 Immunoassay Analyzer. SPSS 16.0 was used for the statistical analysis of the results. Data were expressed as mean±standard deviation unless otherwise described. The differences about clinical characteristics between the AMI patients and controls were tested using Student's t test or Fisher's exact test. The Mann-Whitney U test was conducted to compare the expression of microRNAs between the AMI patients and controls. MicroRNAs expression between different intervals of the AMI patients was compared using Wilcoxon's signed-rank test. The receiver operating characteristic(ROC) curve was established to discriminate the AMI patients from the controls.RESULTS:In the present study,the expression of plasma miR-1 was signifi cantly increased in the AMI patients compared with the healthy controls(P<0.01). The plasma miR-1 in the AMI patients decreased to the normal level at 14 days(P>0.05). The expression of plasma miR-1 was not related to the clinical characteristics of the study population(P>0.05). ROC curve analyses demonstrated that miR-1 was specifi c and sensitive for the early diagnosis of AMI,but not superior to cTnT.CONCLUSION:Plasma miR-1 could be used in the early diagnosis of AMI,but it is similar to cTnT.

The combination of creatine kinase-myocardial band isoenzyme and point-of-care cardiac troponin/contemporary cardiac troponin for the early diagnosis of acute myocardial infarction

BACKGROUND:The early diagnosis of acute myocardial infarction(AMI)remains challenging,especially for institutions without the high-sensitive cardiac troponin(hs-c Tn)assay.Herein,we aim to assess the value of creatine kinase-myocardial band isoenzyme(CK-MB)combined with different cardiac troponin(c Tn)assays in AMI diagnosis.METHODS:This multicenter,observational study included 3,706 patients with acute chest pain from September 1,2015,to September 30,2017.We classified the participants into three groups according to the c Tn assays:the point-of-care c Tn(POC-c Tn)group,the contemporary c Tn(c-c Tn)group,and hs-c Tn group.The diagnostic value was quantified using sensitivity and the area under the curve(AUC).RESULTS:Compared to the single POC-c Tn/c-c Tn assays,combining CK-MB and POC-c Tn/c-c Tn increased the diagnostic sensitivity of AMI(56.1%vs.63.9%,P<0.001;82.7%vs.84.3%,P=0.025).In contrast,combining CK-MB and hs-c Tn did not change the sensitivity compared with hs-c Tn alone(95.0%vs.95.0%,P>0.999).In the subgroup analysis,the sensitivity of combining CKMB and c-c Tn increased with time from symptom onset<6 h compared with c-c Tn alone(72.8%vs.75.0%,P=0.046),while the sensitivity did not increase with time from symptom onset>6 h(97.5%vs.98.3%,P=0.317).The AUC of the combination of CK-MB and POC-c Tn significantly increased compared to the single POC-c Tn assay(0.776 vs.0.750,P=0.002).The AUC of the combined CKMB and c-c Tn/hs-c Tn assays did not significantly decrease compared with that of the single c-c Tn/hs-c Tn assays within 6 h.CONCLUSIONS:The combination of CK-MB and POC-c Tn or c-c Tn may be valuable for the early diagnosis of AMI,especially when hs-c Tn is not available.

CTnT、Hcy、hs-CRP、LP(a)联合检测在缺血性脑卒中评估中的诊断价值研究

目的研究心肌肌钙蛋白T(cardiac troponinT,cTnT)、同型半胱氨酸(homocysteine,Hcy)、超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)、血清脂蛋白-α[lipoprotein-α,LP(a)]联合检测在缺血性脑卒中风险评估中的诊断价值。方法回顾性分析2020年3月—2022年2月盱眙县中医院诊治的258例发生缺血性脑卒中患者与同期的72例健康体检者的临床资料。全部研究对象进行各项指标联合检测,对比不同研究对象之间各项指标水平,各项指标联合诊断效能。结果缺血性脑卒中患者各项生化指标水平均高于健康体检者,差异有统计学意义(P<0.05)。重度缺血性脑卒中各项指标水平高于中度、轻度缺血性脑卒中患者,差异有统计学意义(P<0.05)。联合检测准确度为97.58%,特异度为98.61%,灵敏度为97.29%,Kappa值为0.931。结论在针对缺血性脑卒中进行风险评估时,不同缺血性脑卒中等级患者生化指标存在显著差异,选择生化实验室联合检测能够具有更高的准确度,建议在临床风险评估中予以积极借鉴。

Characteristics of elevated cardiac troponin I in patients with acute ischemic stroke

Objective To study prognostic characteristics of cardiac troponin I （cTnI） elevation in acute ischemic stroke. Methods We retrospectively studied patients （n = 248） with acute ischemic stroke, acute ST-segment elevation myocardial infarction, and acute non-ST-elevation myocardial infarction who were treated between January 2013 and October 2015. Baseline demographic data and changes in cTnI levels among these three groups were compared. Patients with acute ischemic stroke were assigned to either the cTnI elevation group （cTnI 〉 0.034 ng/mL） or the no cTnI elevation group （cTnI ≤ 0.034 ng/mL）. Logistic regression analysis was used to identify risk factors associated with elevated serum cTnI in patients with acute ischemic stroke. Moreover, the duration of hospital stay and incidence of major cardiovascular outcomes were compared in patients with acute ischemic stroke, with or without elevated cTnI. Results In this study population of patients with acute ischemic stroke （n = 178）, acute ST-segment elevation myocardial infarction （n = 35）, and acute non-ST-elevation myocardial infarction （n = 35）, patients with acute ischemic stroke with elevated cTnI comprised 18.54% of subjects. Patients with elevated cTnI were older and more likely to have a history of hypertension. In addition, these patients had higher levels of inflammatory markers, reduced renal functions, increased D-dimer levels, higher NIH stroke scores, and lower left ventricular ejection fractions. Logistic regression analysis showed that both percentage of neutrophil and NIH stroke scores were elevated; estimated glomerular filtration rate and left ventricular ejection fraction were decreased in patients with acute ischemic stroke who had elevated cTnI, and they had more frequent major cardiovascular events during hospital stay. Conclusion Elevated cTnI detected in patients with acute ischemic stroke, indicated a greater likelihood of poor short-term prognosis during hospital stay.

A MXene-functionalized paper-based electrochemical immunosensor for label-free detection of cardiac troponin I

Convenient,rapid,and accurate detection of cardiac troponin I(cTnI)is crucial in early diagnosis of acute myocardial infarction(AMI).A paper-based electrochemical immunosensor is a promising choice in this field,because of the flexibility,porosity,and cost-efficacy of the paper.However,paper is poor in electronic conductivity and surface functionality.Herein,we report a paper-based electrochemical immunosensor for the label-free detection of cTnI with the working electrode modified by MXene(Ti_(3)C_(2))nanosheets.In order to immobilize the bio-receptor(anti-cTnI)on the MXene-modified working electrode,the MXene nanosheets were functionalized by aminosilane,and the functionalized MXene was immobilized onto the surface of the working electrode through Nafion.The large surface area of the MXene nanosheets facilitates the immobilization of antibodies,and the excellent conductivity facilitates the electron transfer between the electrochemical species and the underlying electrode surface.As a result,the paper-based immunosensor could detect cTnI within a wide range of 5-100 ng/mL with a detection limit of 0.58 ng/mL.The immunosensor also shows outstanding selectivity and good repeatability.Our MXene-modified paper-based electrochemical immunosensor enables fast and sensitive detection of cTnI,which may be used in real-time and cost-efficient monitoring of AMI diseases in clinics.

Prognostic value of high-sensitivity cardiac troponin T in patients with en-domyocardial-biopsy proven cardiac amyloidosis

Objective To investigate prognostic predictors of long-term survival of patients with cardiac amyloidosis （CA）, and to determine predictive value of high-sensitivity cardiac troponin T （hs-cTnT） in CA patients. Methods We recruited 102 consecutive CA cases and followed these patients for 5 years. We described their clinical characteristics at presentation and used a new, high-sensitivity assay to determine the concentration of cTnT in plasma samples from these patients. Results The patients with poor prognosis showed older age （56 ±12 years vs. 50 ±15 years, P=0.022）, higher incidences of heart failure （36.92%vs. 16.22%, P=0.041）, pericardial effusion （60.00%vs. 35.14%, P=0.023）, greater thickness of interventricular septum （IVS） （15 ±4 mm vs. 13 ±4 mm, P=0.034）, higher level of hs-cTnT （0.186 ±0.249 ng/mL vs. 0.044 ±0.055 ng/mL, P=0.001） and higher NT-proBNP （N-terminal pro-B-type natriuretic pep-tide） levels （11,742 ± 10,464 pg/mL vs. 6,031 ± 7,458 pg/mL, P=0.006）. At multivariate Cox regression analysis, heart failure （HR：1.78, 95%CI：1.09-2.92, P=0.021）, greater wall thickness of IVS （HR：1.44, 95%CI：1.04-3.01, P=0.0375） and higher hs-cTnT level （HR：6.16, 95%CI：2.20-17.24, P=0.001） at enrollment emerged as independent predictors of all-cause mortality. Conclusions We showed that hs-cTnT is associated with a very ominous prognosis, and it is also the strongest predictor of all-cause mortality in multivariate analysis. Examination of hs-cTnT concentrations provides valuable prognostic information concerning long-term outcomes.

Impact of training specificity on exercise-induced cardiac troponin elevation in professional athletes: A pilot study

BACKGROUND Release of cardiac biomarkers is common after strenuous endurance exercise,but data on intermittent exercise are scarce.It has not been investigated whether cardiac troponin elevation is influenced depending on the type of exercise that an athlete is adapted to perform.We hypothesized that intermittent but not continuous exercise induces cardiac troponin elevation in professional athletes adapted to high-intensity intermittent exercise.AIM To examine how training specificity impacts high-sensitivity cardiac troponin T(hs-cTnT)release.METHODS Nine professional floorball players participated in the study,which comprised two different exercise tests:a continuous incremental cycle ergometer test and a Yo-Yo Intermittent Recovery 2(Yo-Yo IR2)test.Serial assessment of hs-cTnT was performed after the cycle ergometer test and the Yo-Yo IR2 test(baseline,0,2,6,and 24 h).RESULTS No hs-cTnT elevation above the myocardial damage cutoff(≥14 ng/L)was shown after the cycle ergometer test,whereas hs-cTnT levels rose over the cutoff in three of nine participants after the Yo-Yo IR2 test.The hs-cTnT levels peaked at 6 h after both tests,but were significantly higher after the Yo-Yo IR2 test compared to the cycle ergometer test(median hs-cTnT concentration 10.6 ng/L vs 7.8 ng/L,P=0.038).All levels returned to baseline within 24 h.CONCLUSION In professional athletes adapted to high-intensity intermittent exercise,hs-cTnT was significantly elevated after intermittent but not continuous exercise.This principle of specificity training should be considered when designing future studies to avoid misinterpretation of hs-cTnT elevation.

Troponin based studies in search of a biomarker for cardiac arrest

Cardiac arrest is shown to be a cause of a large number of deaths not only in Pakistan but around the globe. The prevalence of this dis-ease demands identification of its etiology. The science of proteomics can be used to identify cardiac specific proteins. The subsequent over expression or under expression of these pro-teins can be utilized as targets not only for therapeutical interventions but also for identi-fying molecular signatures for Cardiac diseases. In context of a number of studies which have shown that the specificity of serum biomarkers like troponin (cTnI and cTnT) are questionable as they may also appear in serum in pathologi-cal conditions other than cardiac dysfunction, the search of a specific marker for cardiac arrest becomes imperative. In this study protein pro-filing of cardiac arrest patients was performed after its quantification through Bradford assay. SDS-PAGE and 2 DE techniques were used as to characterize proteins. The samples of the pa-tients prior to characterizing of proteins were subjected to lipid and cardiac enzymes profiling. The results of these investigations have shown an increase in almost all of these parameters by many folds from that of normal values. In addi-tion to this the samples were found out to be positive for troponin T which strongly confirms the incidence of the cardiac arrest. The results of SDS-PAGE exhibited the induction of three proteins of 100 kDa, 97 kDa and of 66 kDa with 100 kDa as the most highly expressed protein. In addition to that SDS-PAGE gels have shown the down regulation of 45 kDa protein, again indi-cating the changes as a result of cardiac arrest. 2DE gel patterns of cardiac arrest samples demonstrated higher number of protein spots as compare to control in the alkaline range, which might suggest their role in cardiac dysfunction. Therefore it can be concluded that this study may pave the grounds for identification of such proteins which can serve not only as potential therapeutical targets but also as candidate markers for accurate diagnosis of the disease.

慢性心力衰竭不同心功能分级患者hs-cTnT与心肌纤维化指标变化

目的:分析慢性心力衰竭(CHF)不同心功能分级患者超敏心肌肌钙蛋白T(hs-CTnT)与心肌纤维化(MF)指标[透明质酸(HA)、层粘蛋白(LN)、Ⅲ型前胶原(PCⅢ)]变化。方法:回顾性分析180例CHF患者临床资料,根据不同NYHA心功能分级分为Ⅱ级组(n=63)、Ⅲ级组(n=61)及Ⅳ级组(n=56),比较各组临床资料、心功能标志物与MF指标差异。结果:各组中,除Ⅳ级组年龄大于Ⅱ级组、Ⅲ级组(P<0.05),其余性别、吸烟史、饮酒史、原发疾病等指标比较,差异均无统计学意义(P>0.05)。各组收缩压、舒张压比较,差异无统计学意义(P>0.05);Ⅳ级组心率高于Ⅱ级组(P<0.05);6MWT:Ⅳ级组<Ⅲ级组<Ⅱ级组(P<0.05)。各组hs-cTnT、N末端B型利钠肽原(NT-ProBNP)、C反应蛋白(CRP)水平:Ⅳ级组>Ⅲ级组>Ⅱ级组(P<0.05)。各组HA、LN、PCIII水平:Ⅳ级组>Ⅲ级组>Ⅱ级组(P<0.05)。结论:CHF患者hs-cTnT与血清HA、LN、PCIII水平呈现随NYHA心功能分级增高而提升的趋势,提示该四项指标在评估CHF心功能受损程度方面具有一定的临床参考价值。

Aptamer-Based Fluorescent Assay for Sensitive Detection of Cardiac Troponin Ⅰ

Acute myocardial infarction(AMI)is a major health problem leading to high rates of mortality and morbidity.Biomarker cardiac troponin I(cTnI)has shown high sensitivity and specificity towards AMI detection,and has been regarded as"gold standard".An ultrasensitive method to detectcTnI with low concentration in human fluid is essential.In this paper,we developed an aptamer-based assay coupled with rolling circle amplification(RCA)and molecular beacon probe for sensitive detection ofcTnI.In this strategy,aptamer acts as a bridge to communicate between oligonucleotides andcTnI.RCA reaction produces a single-stranded tandem repeated copy of the circular template,which are recognized by fluorescence molecular beacon probe.With this strategy,highly sensitive and specific detection of cTnI was realized with the lowest detectable concentration of 7.24 pg/m L.The developed aptamer-RCA assay can be a promising tool in clinical samples analysis.The assay can also analyze other disease-related biomarkers by replacing the aptamer.

外周血cTnT、Hcy及miRNA-92表达水平对急性冠状动脉综合征患者病情严重程度及短期预后的诊断价值

目的探讨外周血心肌肌钙蛋白T(cardiac troponin T,cTnT)和同型半胱氨酸(homocysteine,Hcy)及微小RNA(microRNA,miRNA)-92表达水平对急性冠状动脉综合征(acute coronary syndromes,ACS)患者病情严重程度及短期预后的诊断价值。方法选取广安市人民医院心血管科于2020年1月至2021年1月收治的206例ACS患者作为研究对象。分析外周血c TnT、Hcy及miRNA-92表达水平与Gensini评分的相关性,并对患者治疗后30 d进行随访,观察再次发生主要不良心血管事件(major adverse cardiac events,MACE)情况,建立ACS患者30 d MACE的预测模型,并对模型的诊断效能进行分析。结果206例患者中急性心肌梗死(acute myocardial infarction,AMI)患者135例(65.5%),不稳定型心绞痛(unstable angina,UA)患者71例(34.5%),冠状动脉单支病变25例(12.1%),双支病变62例(30.1%),多支病变119例(57.8%)。与UA组患者比较,AMI组患者外周血cTnT、Hcy和miRNA-92表达水平明显升高,差异具有统计学意义(P<0.05)。而不同冠状动脉病变支数组患者间上述指标比较,差异无统计学意义(P>0.05)。多元线性回归分析提示,外周血c TnT、Hcy和miRNA-92表达水平与Gensini评分呈正相关,回归方程为Y_(Gensini)=27.269+1.870×X_(miRNA)-92+1.595×X_(cTnT)+0.827×X_(Hcy)。不同预后患者二元Logistic回归分析提示,外周血c TnT、Hcy和miRNA-92表达水平升高是ACS患者30 d内并发MACE的独立危险因素,联合上述3个指标预测MACE发生的AUC较单个指标显著提升,结果具有统计学意义(P<0.01)。结论外周血cTnT、Hcy和miRNA-92表达水平与ACS患者病情严重程度密切相关,且联合上述3个指标可显著提升对ACS患者短期预后的预测价值。

Role of cardiac magnetic resonance imaging in troponinemia syndromes

Cardiac magnetic resonance imaging(MRI)is an evolving technology,proving to be a highly accurate tool for quantitative assessment.Most recently,it has been increasingly used in the diagnostic and prognostic evaluation of conditions involving an elevation in troponin or troponinemia.Although an elevation in troponin is a nonspecific marker of myocardial tissue damage,it is a frequently ordered investigation leaving many patients without a specific diagnosis.Fortunately,the advent of newer cardiac MRI protocols can provide additional information.In this review,we discuss several conditions associated with an elevation in troponin such as myocardial infarction,myocarditis,Takotsubo cardiomyopathy,coronavirus disease 2019 related cardiac dysfunction and athlete’s heart syndrome.

Marked elevation of troponin I without wall motion abnormality in a patient with myocarditis: Cardiac enzymes may not predict the outcome in myocarditis

A seventeen-year-old male presented with severe substernal chest pain after an episode of upper respiratory tract infection. On clinical grounds, a diagnosis of myocarditis was established. He had a peak troponin I level as high as 40.4 ng/dl but interestingly with no abnormal wall motion and normal ejection fraction in echocardiography. Coronary artery disease was excluded with normal coronary angiography. Diagnosis of myocarditis was confirmed with cardiac MRI. After one month, patient had no complaint and ejection fraction were still normal. Our case emphasizes that the troponin levels predict neither the early nor the late outcome of the left ventricular functions in myocarditis, therefore serum troponin I may not be helpful in determining the prognosis of patients with myocarditis.

Differential IFN-Gamma (IFN-γ), Interleukin 10 (IL-10) and Cardiac Troponin I (cTnI) Responses in Natural Bovine Trypanosomosis in Nigeria

Trypanosomosis is major drawback to profitable livestock production in sub-Sahara African, including Nigeria. Knowledge of the cytokines production in the phase of natural infection may help to better diagnose, treat and prevent bovine trypanosomosis. The purpose of the this study was to determine the levels of interferon-gamma (IFN-γ), interleukin-10 (IL-10) and cardiac troponin–I (cTnI) in the sera of cattle naturally infected with T. brucei, T. congolense and T. vivax and correlate these levels with parasitaemia and PCV of the infected animals. Five milliliter of blood samples were collected via the jugular vein from 411 randomly selected cattle into EDTA and non-citrated bottle. PCV was determined manually using HCT. Trypansomes were detected and characterized by microscopy and PCR, respectively. Serum levels of IFN-γ, IL-10 and cTnI were determined using commercial ELISA kit. Data were summarized using descriptive statistic and significance of differences determined by ANOVA. Of the 62 samples positive for trypanosomes by microscopy, 50 samples were confirmed to species level by PCR. The sera levels of IFN-γ, IL-10 and cTnI of infected cattle were higher than non-infected cattle. The differences were not significant (p γ, IL-10 and cTnI in cattle with natural trypanosomosis. Further investigation is required to understand the specific effect of trypanosomes on myocardiac integrity and interaction between the two cytokines in natural trypanosomosis in cattle.

Correlation of cardiac troponin T levels with inotrope requirement,hypoxic-ischemic encephalopathy,and survival in asphyxiated neonates

BACKGROUND Cardiac involvement in neonates with perinatal asphyxia not only complicates perinatal management but also contributes to increased mortality.AIM To assess cardiac troponin T(cTnT)levels in asphyxiated neonates and their correlation with echocardiography findings,inotrope requirement,hypoxicischemic encephalopathy(HIE)stages,and mortality.METHODS cTnT levels,echocardiographic findings,the requirement of inotropes,HIE stages,and outcome were studied in neonates of gestational age≥34 wk with perinatal asphyxia.RESULTS Among 57 neonates with perinatal asphyxia,male gender,cesarean section,forceps/vacuum-assisted vaginal delivery and late preterm included 33(57.9%),23(40.4%),3(5.3%),and 12(21.1%)respectively.The mean gestational age was 38.4 wk(1.6 wk).HIE stages I,II,and III were observed in 7(12.3%),37(64.9%),and 9(15.8%)neonates respectively.26(45.6%)neonates had echocardiographic changes and 19(33.3%)required inotropes.cTnT levels were elevated in 41(71.9%)neonates[median(IQR);0.285(0.211-0.422)ng/mL].The Median cTnT level showed an increasing trend with increasing changes in echocardiography(P=0.002).Two neonates with mitral regurgitation and global hypokinesia had the highest cTnT levels(1.99 and 0.651 ng/mL).Of 31 neonates with normal echocardiography,18(58.06%)showed elevated cTnT.cTnT levels were significantly higher in those who required inotropic support than those who did not(P=0.007).Neonates with HIE stage III had significantly higher cTnT levels compared to those with HIE stage I/II(P=0.013).Survivors had lower median cTnT levels[0.210(0.122-0.316)ng/mL]than who succumbed[0.597(0.356-1.146)ng/mL].CONCLUSION cTnT levels suggestive of cardiac involvement were observed in 71.9%of asphyxiated neonates.cTnT levels correlated with echocardiography findings,inotrope requirement,HIE stages,and mortality.