High-sensitivity cardiac troponin T in young, healthy adults undergoing non-cardiac surgery.
High-sensitivity cardiac troponin T in young, healthy adults undergoing non-cardiac surgery.
复制标题
接受非心脏手术的年轻健康成年人的高敏心肌肌钙蛋白 T。
DOI：
10.1016/j.bja.2017.09.001
复制
发表时间：
2018
影响因子：
9.8
通讯作者：
Nagele,P
中科院分区：
文献类型：
--
作者：
Duma,A;Wagner,C;Titz,M;Maleczek,M;Hüpfl,M;Weihs,VB;Samaha,E;Herkner,H;Szekeres,T;Mittlboeck,M;Scott,MG;Jaffe,AS;Nagele,P
目前尚不清楚孤立的术后心肌肌钙蛋白升高（通常称为心肌损伤）是否代表一种病理事件，因为缺乏其他健康成人的对照研究。方法在这项单中心前瞻性观察队列研究中，对接受择期骨科手术的年轻健康成人在术前、术后2-6小时和术后18-30小时三个时间点的连续高敏心肌肌钙蛋白T （hscTnT）血浆浓度进行了检测。终点为术后hscTnT升高：≥20%（超过分析变异性），≥50%（超过短期生物学变异性），≥85%（超过长期生物学变异性）。次要终点为心肌损伤，定义为术后新hscTnT升高bbb99 %参考上限（URL）（女性> 10ng升−1；男性> 15ng升−1）。结果在研究人群（n=95）中，68例（73%）患者未检测到hscTnT升高≥20%。17例（18%）患者hscTnT升高20% - 49%，7例（7%）患者hscTnT升高50-84%，3例（3%）患者hscTnT升高≥85%。20例患者（21%）的绝对浓度ΔhscTnT在0 - 2ng升- 1之间，12例患者（13%）在2 - 4ng升- 1之间，3例患者在4 - 6ng升- 1之间，1例患者（1%）在6 - 8ng升- 1之间。1例（1%）患者被诊断为心肌损伤（新hscTnT升高bb0.99 %）。术后hscTnT浓度中位数没有增加，基线时为4（3.9-5，四分位数间范围）ng升- 1，术后2-6小时为4 (3.9-5)ng升- 1，术后第1天为4 (3.9-5)ng升- 1。结论：1 / 4无已知心血管疾病的年轻成人患者术后hscTnT升高，但未超过99% URL，无心肌缺血证据。这些结果可能对术后心肌损伤的概念产生重要影响，因为它们表明，在一些患者中，术后心肌肌钙蛋白升高可能是手术环境中正常生理过程的结果。临床试验注册：nct 02394288。
BackgroundIt is unclear if isolated postoperative cardiac-troponin elevation, often referred to as myocardial injury, represents a pathological event, as control studies in otherwise healthy adults are lacking.MethodsIn this single-centre prospective observational cohort study, serial high-sensitivity cardiac troponin T (hscTnT) plasma concentrations were obtained from young, healthy adults undergoing elective orthopaedic surgery at three time points: before operation, 2–6 h, and 18–30 h after surgery. End points were hscTnT increases after surgery: ≥20% (exceeding analytical variability), ≥50% (exceeding short-term biological variability), and ≥85% (exceeding long-term biological variability). The secondary end point was myocardial injury, defined as new postoperative hscTnT elevation >99th % upper reference limit (URL) (women >10 ng litre−1; men >15 ng litre−1).ResultsAmongst the study population (n=95), no hscTnT increase ≥20% was detected in 68 patients (73%). A hscTnT increase between 20% and 49% was observed in 17 patients (18%), 50–84% in seven patients (7%), and ≥85% in three patients (3%). Twenty patients (21%) had an absolute ΔhscTnT between 0 and 2 ng litre−1, 12 patients (13%) between 2 and 4 ng litre−1, three patients between 4 and 6 ng litre−1, and one patient (1%) between 6 and 8 ng litre−1. Myocardial injury (new hscTnT elevation >99th%) was diagnosed in one patient (1%). The median hscTnT concentrations did not increase after operation, and were 4 (3.9–5, inter-quartile range) ng litre−1at baseline, 4 (3.9–5) ng litre−1at 2–6 h after surgery, and 4 (3.9–5) ng litre−1on postoperative day 1.ConclusionsOne in four young adult patients without known cardiovascular disease developed a postoperative hscTnT increase, but without exceeding the 99th% URL and without evidence of myocardial ischaemia. These results may have important ramifications for the concept of postoperative myocardial injury, as they suggest that, in some patients, postoperative cardiac-troponin increases may be the result of a normal physiological process in the surgical setting.Clinical trial registrationNCT 02394288.