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医疗机构及临床医生应如何设置与解读Hs-cTn?

CBSMD

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高敏肌钙蛋白I或T检测(hs-cTnI/T)已在全球推广开来, “Recommendations for Institutions Transitioning to High-Sensitivity Troponin Testing： JACC Scientific Expert Panel”可谓hs-cTn百科全书，从医疗机构到临床医生、从急诊到住院、从心肌梗死到排除诊断，多角度地介绍了医疗机构如何在日常临床中实现从cTn检测到hs-cTn检测的过渡，指出了该过程中所涉及的实验室、临床诊疗中的技术细节。欢迎各位专家访问CBS Scientific Library-右侧文献进一步阅览原文，以下为其中的关键点：

医疗机构实验室应如何实现从cTn检测过渡到hs-cTn检测：

1. 实验室专家应对阈值的选择做出谨慎的考量，对于肌钙蛋白而言，第99百分位作为健康人群的公认阈值上限，等于或低于此阈值会增加肌钙蛋白假阳性结果，此阈值已被纳入《第四版心肌梗死通用定义》中。

2. 敏感度

(1) hs-cTn是可实现在心肌梗死发作短时间内检测到心肌损伤的高敏指标，相对于cTn检测，hs-cTn检测进一步优化了信噪比（signal-to-noise ratio）;

(2) hs-cTn检测的高敏感度体现在男性和女性患者不同的检测阈值上；

(3) 实验室负责人对hs-cTn的选择应基于现有cTn检测仪器的类别；因缺乏足够的数据支持，现阶段不建议推行床旁hs-cTn检测（point-of-care hs-cTn）；

(4) 建议一家机构不兼用hs-cTn和cTn检测，不同科室间应统一一种检测法；

(5) Hs-cTn总检测时长应控制在60分钟之内；

(6) 为方便解读检测结果，建议hs-cTnI/T的单位应设为纳克/升，如25ng/l。

临床医生应结合患者的临床表现于hs-cTnI/T检测结果做出不同鉴别诊断，临床决策可参考以下建议：

(1) hs-cTn 升高所涉及的鉴别诊断；

(2) hs-cTn不同水平及其诊断可能；

(3) 使用hs-cTn在不同时间窗内的测量值进行的排除诊断；

(4) 如何将hs-cTn结合其他诊断手段明确急性胸痛患者的收治；

(5) 如何使用hs-cTn指导非介入检查；

(6) hs-cTn在不同临床科室、不同疾病中的解读。

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医疗机构及临床医生应如何设置与解读Hs-cTn?

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