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.

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.

An electrochemiluminescent magneto-immunosensor for ultrasensitive detection of hs-cTnI on a microfluidic chip

Sensitive detection and precise quantitation of trace-level crucial biomarkers in a complex sample matrix has become an important area of research.For example,the detection of high-sensitivity cardiac troponin I (hs-cTnI) is strongly recommended in clinical guidelines for early diagnosis of acute myocardial infarction.Based on the use of an electrode modified by single-walled carbon nanotubes (SWCNTs) and a Ru(bpy)32+-doped silica nanoparticle (Ru@SiO2)/tripropylamine (TPA) system,a novel type of electrochemiluminescent (ECL) magnetoimmunosensor is developed for ultrasensitive detection of hs-cTnI.In this approach,a large amount of[Ru(bpy)3]2+is loaded in SiO2(silica nanoparticles) as luminophores with high luminescent efficiency and SWCNTs as electrode surface modification material with excellent electrooxidation ability for TPA.Subsequently,a hierarchical micropillar array of microstructures is fabricated with a magnet placed at each end to efficiently confine a single layer of immunomagnetic microbeads on the surface of the electrode and enable 7.5-fold signal enhancement In particular,the use of transparent SWCNTs to modify a transparent ITO electrode provides a two-order-of-magnitude ECL signal amplification.A good linear calibration curve is developed for hs-cTnI concentrations over a wide range from 10 fg/ml to 10 ng/ml,with the limit of detection calculated as 8.720 fg/ml (S/N=3).This ultrasensitive immunosensor exhibits superior detection performance with remarkable stability,reproducibility,and selectivity.Satisfactory recoveries are obtained in the detection of hs-cTnI in human serum,providing a potentia analysis protocol for clinical applications.

不同ASA分级老年患者术后心脏事件的观察

老年患者因术前常合并隐匿性心脑肺等疾病,麻醉风险较大,故术前评估较为重要。目前临床上多采用ASA分级评估麻醉风险,但该分级标准受麻醉医师主观因素的影响较大,应结合一些客观便捷的指标进行麻醉前风险评估。本研究通过检测老年患者麻醉前后B型尿钠肽（B-type natriuretic peptide,BNP）和肌钙蛋白T浓度（cardiac troponin T,cTnT）,

血清Cys C、NT-proBNP和cTnI在不同病变程度冠心病患者中的表达及意义

目的 探讨血清Cys C、NT-proBNP和cTnI在不同病变程度冠心病患者中的表达及意义.方法 选取2014年10月至2015年10月在沈阳医学院附属第二医院收治的80例行冠脉造影术,必要时行PCI的患者作为研究对象,依据冠脉病变支数进行不同组别划分,完成血清Cys C、NT-proBNP和cTnI的临床检验,统计学比较分析.结果 多支病变组Cys C、NT-proBNP和cTnI水平[（1.8 l±0.18）mg/L、（264.5±51.1）pg/ml、（1.06±0.24）ng/ml]显著高于双支病变组[（1A9±0.16）mg/L、（101.2±22.4）pg/ml、（0.09±0.11）ng/ml]、单支病变组[（0.88±0.17）mg/L、（81.7 ±32.7）pg/ml、（0.05±0.06）ng/ml]及对照组[（0.63±0.15）mg/L、（51.6±12.3）pg/ml、（0.01±0.01）ng/ml],且伴随病变支数增加表现出上升趋势,各组数据比较均具有统计学意义（P＜0.05）.结论 推测血清Cys C与NT-proBNP,cTnI一样可作为评估冠脉病变程度的一种经济、方便的初步判断辅助指标.

运动引起心肌肌钙蛋白T释放:心肌可逆性损伤的证据与心肌适应性改变的信号?

心肌肌钙蛋白（Cardiac Troponin．cTn）是被广泛接受的、高特异性心脏标志物．目前已成为判断心肌损伤的“金标准”。与传统心脏标志物相比。cTn更为敏感，能够诊断出微小范围心肌坏（necrosis），因此，对急性心肌坏死的早期诊断具有重要价值。

心脏型脂肪酸结合蛋白的研究进展

近年来，在世界范围内急性心肌梗死（acute myocardial infarction，AMI）发病率持续升高，而对AMI的治疗，再灌注治疗的效果与时间呈显著负相关，早期诊断和治疗具有相当重要的意义。目前临床对于不典型症状或心电图者AMI诊断更多依赖于心肌酶学，而肌红蛋白（myoglobin，MYO）、肌钙蛋白Ⅰ（troponinⅠ，cTnI）及肌酸磷酸激酶（creatine kinasemass，CK-MB）对早期诊断AMI的灵敏度或特异性方面存在缺陷，近年发现心脏型脂肪酸结合蛋白（heart fatty acidbinding pro-tein,H-FABP）早期诊断缺血性心肌损伤的有效性,现综述如下。

肌钙蛋白在儿童心肌损伤中的应用

心肌肌钙蛋白（cardiac Troponin,cTn）是心肌纤维蛋白特有的成分,广泛存在于心肌细胞内,当有心肌细胞破坏时,cTn释放到细胞外而进入血液。目前肌钙蛋白已成为早期诊断急性心肌梗死标专物之一。cTn存在不同的异构形式,随着胎儿逐渐成熟,渐被成人心脏异构形式取代,出生时只有成人异构形成cTn被检测出,即新生儿、儿童及成年人等各阶段cTn相同,不仅是诊断成人急性心肌损害的金标准,

心肌肌钙蛋白Ⅰ在冠状动脉旁路移植术后的变化规律

目的 分析心肌肌钙蛋白Ⅰ（cTnI）在冠状动脉旁路移植术后的变化规律.方法 选择体外循环（ONCAB）与非体外循环（OPCAB）冠状动脉旁路移植术患者各40例,术前即刻、术后即刻、第1天、第2天、第3天、第4天、第5天、第6天、第7天检测cTnI水平.结果 cTnI在ONCAB组与OPCAB组均表现为不同程度的升高,然后逐渐下降;OPCAB组cTnI浓度峰值较ONCAB组显著减低.发生心肌梗死5例,其中ONCAB组3例,OPCAB组2例,cTnI均显著高于正常水平.结论 cTnI在ONCAB组与OPCAB组变化规律均表现为迅速升高,然后逐渐下降.观察cTnI变化,可以判断心肌损伤程度,改善预后.

虾过敏原Troponin C(Pen m6)的克隆表达、免疫学鉴定及生物信息学分析

目的对斑节对虾(Penaeus monodon)第6组过敏原(Pen m6),肌钙蛋白C(Troponin C)进行克隆表达、免疫学鉴定并研究其生物学意义。方法提取斑节对虾总RNA;根据Gen Bank:HM034316.1设计引物及构建表达载体PET-24a-Pen m6;转化至大肠杆菌BL21(DE3)进行表达;纯化后的重组Pen m6用Western bolt来鉴定免疫学特性;用生物信息学相关工具对Pen m6进行同源性分析,并预测其蛋白质的结构和功能。结果克隆出斑节对虾Pen m6基因开放阅读框453 bp,编码150个氨基酸。重组Pen m6蛋白呈可溶性,分子量约35kDa,能够与斑节对虾过敏患者血清IgE结合。斑节对虾与凡纳滨对虾亲缘关系比较近,其中斑节对虾Pen m6蛋白与凡纳滨对虾Troponin C1(gb|AET36896.1|)同源性为98%。理化性质预测Pen m6蛋白质不稳定。蛋白质结构预测结果显示Pen m6的结构主要以α螺旋组成。T细胞抗原表位预测得到4个肽序列(15~23、35~43、91~99、112~120)。B细胞抗原表位预测得到4个肽序列(7~16、21~30、28~37、58~67)。结论克隆的重组斑节对虾Pen m6蛋白具有良好的免疫原性,为进一步研究斑节对虾过敏原的结构成分及其理化性质奠定理论基础。

心肌脂肪酸结合蛋白在急性冠脉综合征早期诊断中的意义

急性冠脉综合征（acute coronary syndrome,ACS）是急诊室的常见病,但死亡率很高,是严重威胁人们生命健康的疾病.心肌梗死发病后能迅速得到确诊并进行再灌注治疗,对于降低死亡率及改善预后十分重要.目前,ACS的诊断主要依据病史、心电图、心肌标志物综合评定.大约1/3的ACS患者无典型的临床症状,约1/2的患者早期无典型的心电图改变,因此,心肌标志物检测在ACS早期诊断中扮演着不可或缺的角色.但是,目前常用的肌红蛋白（myoglobin,Myo）虽出现时间较早,但特异性较差,易受骨骼肌损伤的影响;心肌肌钙蛋白（cardiac troponin I,cTnI）、肌酸激酶同工酶（creatine kinase-MB,CK-MB）在心肌梗死早期（2～4h内）阳性率不高,在发病＞4h才具有诊断价值.

肌钙蛋白在儿童心肌损伤中的应用

心肌肌钙蛋白（cardiac Troponin,cTn）是心肌纤维蛋白特有的成分,广泛存在于心肌细胞内,当有心肌细胞破坏时,cTn释放到细胞外而进入血液。目前肌钙蛋白已成为早期诊断急性心肌梗死标记物之一。cTn存在不同的异构形式，随着胎儿逐渐成熟，渐被成人心脏异构形式取代，出生时只有成人异构形成cTn被检测出，

心肌肌钙蛋白检测在急诊胸痛患者中的临床应用

胸痛是急诊患者中最常见的症状之一,主要表现的疾病中以急性冠脉综合征（acute coronary syndrome,ACS）、肺栓塞（pulmonary embolism,PE）及主动脉夹层（aortic dissection）最为凶险。心肌肌钙蛋白（cardial troponin,cTn）是心肌损伤最特异、最敏感的血清标志物之一,其检测快速,诊断阈值明确，现已成为急诊常用的检测指标。

心肌肌球蛋白结合蛋白C在急性心肌梗死中的表达及其临床意义

目的探讨心肌肌球蛋白结合蛋白C(c My BP-C)在急性心肌梗死(AMI)中的表达及其临床意义。方法选取2011年1月至2013年12月临朐县人民医院收治的50例AMI患者作为AMI组,其中发病时间<4 h 21例,发病时间≥4 h 29例。另外选择同期健康体检者50例作为健康对照组。统计受试者血清c My BP-C、心脏肌钙蛋白I(c Tn I)、肌红蛋白(Myo)水平,并分析AMI患者血清c My BP-C、c Tn I、Myo与年龄、发病时间、体质指数的相关性。结果 AMI组血清c My BP-C、c Tn I、Myo水平均高于健康对照组[(106±16)μg/L比(18±6)μg/L、(10.76±3.32)μg/L比(0.031±0.003)μg/L、(122±33)μg/L比(23±5)μg/L],差异有统计学意义(P<0.01)。发病时间≥4 h组患者血c My BP-C、Myo、c Tn I水平高于发病时间<4 h组[(109±17)μg/L比(76±9)μg/L,(11.67±3.72)μg/L比(0.042±0.006)μg/L,(130±33)μg/L比(93±16)μg/L,P<0.01]。PCI术后患者血c My BP-C水平低于入院时[(59±11)μg/L比(107±16)μg/L,P<0.01],PCI术后患者血c Tn I、Myo水平高于入院时[(33±6)μg/L比(11±3)μg/L,(136±35)μg/L比(122±33)μg/L,P<0.01];血c My BP-C、c Tn I、Myo与AMI发病时间均呈正相关(P<0.05);血c My BP-C、c Tn I、Myo之间均呈正相关(P<0.05)。结论 c My BP-C可以作为AMI早期诊断的指标之一,还可作为评价PCI术早期效果的指标。

心肌肌钙蛋白的理解和应用

心肌肌钙蛋白（cardiac troponin,cT n）是心肌损伤和（或）心肌坏死的敏感标志物,在急性心肌梗死及急性冠状动脉综合征患者的诊断、治疗、危险评估等方面都有着很高的应用价值。但cT n检测值升高,只能是心肌损伤或坏死的表现,不能反映病因。为此,临床上应该更加合理地来理解和应用好该项指标。

斑马鱼TNNT2a相对荧光定量PCR双标准曲线的建立

斑马鱼是一种新型的模式脊椎动物,其生长周期短,饲养成本低,幼体透明,近年来被广泛应用于心血管疾病的实验研究中[1]。肌钙蛋白作为临床上一种重要的心衰标志物,对心血管疾病的临床诊断、治疗和预后评估有重要意义。本实验旨在建立斑马鱼心肌肌钙蛋白（zebrafish troponin T type2a,TNNT2a）基因的相对定量PCR双标准曲线,探究TNNT2a的表达水平。

人Troponin I的表达载体构建诱导表达和纯化及活性测定

以人肝脏cDNA文库为模板,通过PCR方法扩增出Tropon in基因,将其克隆到pCR-TOPO质粒中,构建表达质粒pET-22 b(+)-TnI,转化大肠杆菌BL 21(DE 3)-RPX并进行诱导表达,表达的目的蛋白占菌体总蛋白的20%以上并主要以可溶形式存在。建立了Tropon in I的非亲和色谱纯化工艺,纯化后蛋白产量约为20 mg/L,纯度在90%以上。体外活性实验表明重组蛋白具有良好的抗血管生成。

Biomarkers and Echocardiography in the Postoperative Course of Pulmonary Resection Surgery

Background: The existence of different degrees of inflammatory reaction and right ventricular dysfunction after pulmonary resection is well known, though its detection and clinical relevance have not been sufficiently evaluated. The introduction of new biomarkers, particularly brain natriuretic peptide (BNP) and its prohormone (proBNP), together with dynamic imaging techniques such as echocardiography, could prove useful in assessing such response. The aim of this study is to describe the kinetic curve of these biomarkers during uncomplicated pulmonary resection surgery. Furthemore we have studied the right ventricular function by echocardiography in these patients Methods: Demographic data, antecedents and certain perioperative parameters, as well as plasma proBNP, troponin T and C-reactive protein (CRP) levels, were recorded in 38 patients who underwent pneumonectomy (n= 13 ) and lobectomy (n=25), before and 24, 48 and 72 hours after the operation. A transthoracic echocardiogram was carried out preoperatively and 72 hours after surgery. Results: ProBNP showed a significant increase 24 hours after surgery, with a maximum peak after 72 hours (p<0.001). CRP likewise increased after 24 hours, with an inflammatory peak after 48 hours (p<0.001). The magnitude of the increase in proBNP and CRP was independent of the extent of resection (pneumonectomy versus lobectomy). Echocardiography showed a slight yet statistically significant decrease in right ventricular function (determined by tricuspid annular plane systolic excursion, TAPSE) in the pneumonectomy subgroup (p=0.01). Conclusion: The plasma proBNP elevation curve allows simple evaluation of the degree and time course of right ventricular dysfunction in the immediate postoperative period of uncomplicated pulmonary resection surgery. In stable patients, magnitude of proBNP elevation has no clinical repercussions, while slight echocardiographic changes are detectable only in pneumonectomized patients. Further studies are needed to evaluate the usefulness of abnormal proBNP elevations in predicting cardiorespiratory complications at patients bedside during the immediate postoperative period.