Title: Elevated Troponins

题目：2012年对肌钙蛋白的认识

Author 作者: Semhar Tewelde

I.Background 背景

a.No real robust data exists on the interpretation of elevated troponins 在肌钙蛋白增高的解释上没有绝对的标准

b.Elevated troponins can be difficult to interpret but are often assumed to equal acute coronary syndrome (ACS)

增高的肌钙蛋白的意义是很难确定的，但通常用来确诊急性冠状动脉综合征（ACS）

c.History 历史

i.Troponins began being used in the 1990’s

肌钙蛋白的使用始于1990年代

ii.There are now new ultra-sensitive assays that are meant to be faster and more sensitive for diagnosing ACS

现在有超敏感分析方法，主要是为了更快和更敏感地诊断ACS

iii.Remember that troponin is just a laboratory marker that indicates myocardial necrosis, not necessarily myocardial infarction

要记住，肌钙蛋白只是一个标志心肌坏死的实验室指标，与心肌梗死无必要的联系

II.Interpretation and use of troponins 肌钙蛋白的解释和应用

a. Most important parts of evaluating for ACS

诊断ACS最主要的内容

i.History of present illness 现病史

ii. EKG 心电图

iii.TIMI risk factors TIMI 危险因素

b.Clinical scenarios 临床表现

i.If patient has presumed ACS and elevated troponin but no EKG changes, they should not go to the cath lab unless there is a rise in troponins >20%

如怀疑有ACS的病人有肌钙蛋白，但没有EKG的变化，不要将他们转到导管室，除非肌钙蛋白的增高超过20％

ii.Patient with PE, even with RV dysfunction, troponins are not necessary

肺梗塞的病人，即使有右心室衰竭，肌钙蛋白也不是必要的

iii.CHF patients likely have a baseline elevated troponin so should trend troponins instead of relying on one elevated value

心衰的病人常有肌钙蛋白基础水平增高，因此需要看它的趋势而不是依赖某一个点的值

iv.Chronic kidney disease patients also likely have a baseline elevated troponin so should trend troponins

慢性肾衰的病人的基础肌钙蛋白的水平也常增高，要参考增高趋势

v.Sepsis patients likely have elevated troponins from LV dysfunction, increased oxygen demand, and hypoperfusion

败血症的病人常由于左心衰，氧耗量增加，和低灌注而有肌钙蛋白增高

vi.Pericarditis and myocarditis usually have elevated troponin from inflammation instead of ischemia

心包炎和心肌炎也常由于炎症而不是缺血造成肌钙蛋白增高

vii.All of these scenarios warrant troponin trending

在所有这些情况下，都要考虑肌钙蛋白增高趋势

c.How to trend troponin 如何判断肌钙蛋白增高趋势

i.Next set of troponins should be greater than 3 standard deviations away from the initial set in 3-6 hours

在3－6个小时内，下一个肌钙蛋白的增加要超过基础水平的3个标准差

References 参考文献:

1. Newby LK, Jesse RL, et al. ACCF 2012 Expert Consensus Document on practical clinical considerations in the interpretation of troponin elevations: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2012; 60(23): 2427-2463.