CARDIAC TROPONIN-T IN THE DIAGNOSIS OF MYOCARDIAL INJURY

被引:136
作者
MAIR, J
DIENSTL, F
PUSCHENDORF, B
机构
[1] UNIV INNSBRUCK, INST MED CHEM & BIOCHEM, FRITZ PREGLSTR 3, A-6020 INNSBRUCK, AUSTRIA
[2] UNIV INNSBRUCK, SCH MED, DEPT MED CHEM & BIOCHEM, A-6020 INNSBRUCK, AUSTRIA
[3] UNIV INNSBRUCK, SCH MED, DEPT INTERNAL MED, A-6020 INNSBRUCK, AUSTRIA
关键词
MYOCARDIAL INJURY; MYOCARDIAL INFARCTION; DIAGNOSIS; TROPONIN-T; CONTRACTILE PROTEIN; MYOCARDIAL REPERFUSION; CREATINE KINASE; LACTATE DEHYDROGENASE; ENZYME IMMUNOASSAY; CARDIOSPECIFIC ENZYMES; COTRACTILE PROTEINS; CORONARY ARTERY BYPASS GRAFTING;
D O I
10.3109/10408369209105245
中图分类号
R446 [实验室诊断]; R-33 [实验医学、医学实验];
学科分类号
1001 ;
摘要
In the last several decades serum levels of cardiac enzymes and isoenzymes have become the final arbiters by which myocardial damage is diagnosed or excluded. Because conventionally used enzymes are neither perfectly sensitive nor specific, there is need for a new sensitive and cardiospecific marker of myocardial damage. Cardiac troponin T (TnT) is a contractile protein unique to cardiac muscle and can be differentiated by immunologic methods from its skeletal-muscle isoform. An enzyme immunoassay specific for cardiac TnT is now available in a commercial kit for routine use. The biggest advantage of this assay is its cardiospecificity. TnT measurements, however, are also highly sensitive in diagnosis of myocardial injury and accurately discern even small amounts of myocardial necrosis. TnT measurements are. therefore, particularly useful in patients with borderline CK-MB and in clinical settings in which traditional enzymes fall to diagnose myocardial damage efficiently because of lack of specificity - for example, perioperative myocardial infarction or blunt heart trauma. TnT release kinetics reveal characteristics of both soluble, cytoplasmic, and structurally bound molecules. It starts to increase a few hours after the onset of myocardial damage and remains increased for several days. TnT allows late diagnosis of myocardial infarction. The diagnostic efficiency remains at 98 % until 6 d after the onset of infarct-related symptoms. TnT is also useful in monitoring the effectiveness of thrombolytic therapy in myocardial infarction patients. The ratio of peak TnT concentration on day 1 to TnT concentration at day 4 discriminates between patients with successful (> 1) and failed (less-than-or-equal-to 1) reperfusion. TnT measurements are very sensitive and specific for the early and late diagnosis of myocardial damage and could, therefore, provide a new criterion in laboratory diagnosis of the occurrence of myocardial damage.
引用
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页码:31 / 57
页数:27
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