How to use high-sensitivity cardiac troponins in acute cardiac care
How to use high-sensitivity cardiac troponins in acute cardiac care
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DOI：
10.1093/eurheartj/ehs154
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发表时间：
2012-09-01
影响因子：
39.3
通讯作者：
Jaffe, Allan S.
中科院分区：
文献类型：
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作者：
Thygesen, Kristian;Mair, Johannes;Jaffe, Allan S.
最近发表了在急性心脏护理中使用心肌肌钙蛋白(CTn)测量的建议。1随后，将高灵敏度(Hs)cTn T测定引入常规临床实践。2与其他方法一样，这种方法被称为高灵敏度，可以测量相当数量的明显无病个体的cTn浓度。这些化验方法可以测量每升毫微克的个位数范围内的cTn(1微微克/毫升)，一些研究化验甚至允许检测浓度，1 ng/L 2-4因此，它们提供了参考对象cTn浓度的第99个百分位数(推荐的参考上限[URL])的更准确的计算。这些检测方法用10%的变异系数(CV)来测量URL。2-4 hs-cTn分析的高精确度提高了它们随时间确定cTn细微差异的能力。目前使用的许多分析方法都有一个CV。在第99个百分位数的URL中，10%限制了这种能力。5-7然而，不太精确的cTn检测不会导致临床相关的急性心肌梗死(AMI)的假阳性诊断，并且第99个百分位数URL处的CV，20%仍然被认为是可以接受的。8
Recommendations for the use of cardiac troponin (cTn) measurement in acute cardiac care have recently been published. 1 Subsequently, a high-sensitivity (hs) cTn T assay was introduced into routine clinical practice. 2 This assay, as others, called highly sensitive, permits measurement of cTn concentrations in significant numbers of apparently illness-free individuals. These assays can measure cTn in the single digit range of nanograms per litre (¼picograms per millilitre) and some research assays even allow detection of concentrations, 1 ng/L. 2–4 Thus, they provide a more precise calculation of the 99th percentile of cTn concentration in reference subjects (the recommended upper reference limit [URL]). These assays measure the URL with a coefficient of variation (CV), 10%. 2–4 The high precision of hs-cTn assays increases their ability to determine small differences in cTn over time. Many assays currently in use have a CV. 10% at the 99th percentile URL limiting that ability. 5–7 However, the less precise cTn assays do not cause clinically relevant false-positive diagnosis of acute myocardial infarction (AMI) and a CV, 20% at the 99th percentile URL is still considered acceptable. 8