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1、Comparison of Plasma Cardiac Troponins T an I in Chronically Hemodialyzed Patients in Relation to Cardiac Status and Age,Clin Chem Lab Med 2002; 40(3):240245 2002 by Walter de Gruyter Berlin New York Speaker: 劉秋菁,中华医生网收集http:/www.doctor- 急性心肌梗塞（AMI） 的黃金準則,患者 胸痛的病史 最少持續30分鐘,心電圖 單一階段 ST 上昇 而且其後出現 Q 波,
2、檢驗室 特有的酵素活性 (CK, CK-MB, LDH),POCTnT1.e,中华医生网收集http:/www.doctor- 準則的缺點,AMI 患者中 約有1/3為非典型 或沒有胸痛,約有50% AMI 患者 早期ECG無診斷特徵 約有20% AMI 患者 晚期ECG會診斷失誤 由於其他症狀導致 敏感性及特異性降低,一般的血清標記 特異性不高 (CK, LDH 和異構物) CK 和 LDH 也存在於正常人血中,患者病史,ECG 變化,血清標記,POCTnT2.e,中华医生网收集http:/www.doctor- T Troponin I Myoglobin CK CK-MB CK-MB I
3、soforms LDH,Early detection of AMI,Used to detect AMI,Elevated in 3-4 hours,Cardiac specific,Elevated after 10 days,Detects MMD,Risk stratifi- cation in UAP,Prognostic value,POCTnT7.e,中华医生网收集http:/www.doctor- 血清標記, 0.1 ng/ml 1 - 6 h 10 - 24 h 5 - 14 d,因方法 不同而異 3 - 6 h 18 - 20 h 5 - 7 d, 1.5 1 - 6 h
4、4 - 8 h 1 - 2 d,5 - 10 ng/ml 10 - 25 U/l 3 - 6 h 12 - 24 h 2 - 3 d, 6 %,60 - 80 ng/ml 1 - 2 h 6 - 12 h 0.5 - 1.5 d,參考範圍,開始上昇,高峰期,回復正常,TnT,TnI,Myoglobin,CK-MB,Isoforms MB2/MB1,CK-MB/CK,POCTnT3.e,中华医生网收集http:/www.doctor- Complex,Troponin I 具有抑制acitin-myosin ATPase 的作用(具心肌專一性) Troponin C 負責與Ca離子的結合 (不具
5、心肌專一性) Troponin T 是將TnI與TnC的結合訊息傳 遞至其它調節收縮蛋白 (具心肌專一性) Troponins Complex 在心肌及骨骼肌中扮演 調節肌肉收縮的重要角色,中华医生网收集http:/www.doctor- Introduction Patients Materials and Methods Results Discussion,中华医生网收集http:/www.doctor- is a lack of correlation between the two markers in CRF patients and it has been suggested t
6、hat the discreancies may be due to greater sensitivity of the cTnT assay compared to the cTnI assay,The clinical value of cardiac troponin I (cTnI) and troponin T (cTnT) in patients with chronic renal failure (CRF) remains, however a subject of debate. Many investigators have reported that cTnT may
7、be elevated in CRF patients in the absence of ischemic heart disease. False elevations of cTnI are more controversial: some studies have demonstrated an advantage of cTnI over cTnT in renal insufficiency, but there are recent indications of cTnI elevations in CRF patients without ischemic heart dise
8、ase,中华医生网收集http:/www.doctor- AMI, acute myocardial infarction CHD,coronary heart disease CRF, chronic renal failure cTnI, cardiac troponin I cTnT, cardiac troponin T hs CRP, high sensitivity C-reactive protein Stratus CS, Stratus Cardiac System URL, upper reference limit,中华医生网收集http:/www.doctor- The
9、 mean age of the patients was 60.114.8 years (range: 2388 years) The length of dialysis averaged 7.2 years (SD: 7.1, range: 130 years) 49位 patients-CHD(+)group 48位patients-CHD(-)group n=97 CRF patients,中华医生网收集http:/www.doctor- Collected The patients were followed during a period of 9 months and bloo
10、d samples were taken at 3-month intervals (T1, T2, T3 andT4) Samples were obtained before the first dialysis of the week to avoid possible changes in troponin levels during dialysis Venous blood was collected immediately before dialysis and tubes were centrifuged (5 min at 1000 g) upon arrival in th
11、e laboratory,cTnT cTnT was determined by third generation immunoassay Using Elecsys analyzer (Roche Diagnostics,Mannheim,Germany) Sample tube-EDTA-plasma Principle: This assay uses two monoclonal antibodies specifically directed against human cTnT,The detection limit is 0.01 g/l. The upper reference
12、 limit (URL) is 0.04 g/l Acute myocardial infarction (AMI) is 0.1g/l.,中华医生网收集http:/www.doctor- cTnI was a two-site fluorimetric immunoassay using the Stratus Cardiac System (Stratus C; Dade Behring S.A., Paris) Sample tube-Lithium heparin Principle: two monoclonal antibodies recognizing both free an
13、d complexed cTnI The detection limit is (0.01 g/l) The URL is 0.08 g/l The cut-off value for AMI is 0.4 g/l (package insert).,中华医生网收集http:/www.doctor- 1 Comparison of percentages of cTnT elevations above URL (0.04 g/l) and treshold limits for AMI (0.1 and 0.2 l) in CHD() and CHD(+) CRF patients. Per
14、centages are given at each measurement time (T1 to T4). T1, T2, T3, T4.,Figure 1 cTnT in CHD(-) patients 1.above the URL of 0.04 g/l (up to 48.6% ) 2. above the cut-off for AMI 0.1ug/l (21.6% ) 3. Over 0.2ug/l(2.7%) 24 patients (50%) had plasma levels 0.04 g/l 17 patients (35.4%) had cTnT values con
15、sistently increased above the URL 7 patients had cTnT levels which fluctuated with time around the URL.,中华医生网收集http:/www.doctor- in CHD(+) patients 1.above the URL of 0.04g/l (up to 79.6%) 2.above the cut-off for AMI 0.1ug/l(up to 37.8%) 3.over 0.2ug/l(up to 18.4%),中华医生网收集http:/www.doctor- 2 Comparison of percentages of cTnI elevations above URL
