肌钙蛋白、脑钠肽在非心脏手术后心肌损伤中的诊断价值
Diagnostic Value of Cardiac Troponin and Brain Natriuretic Peptide in Myocardial Injury after Non Cardiac Surgery
DOI: 10.12677/acm.2024.14102785, PDF,   
作者: 任 童*, 安肖霞#：浙江大学医学院附属第一医院麻醉科，浙江 杭州
关键词: 肌钙蛋白；脑钠肽；非心脏手术后心肌损伤；Troponin； Brain Natriuretic Peptide； Myocardial Injury after Non Cardiac Surgery
摘要: 非心脏手术后心肌损伤(Myocardial Injury after Noncardiac Surgery, MINS)是围手术期常见的并发症，其诊断与评估对于改善患者预后具有重要意义。肌钙蛋白(Cardiac Troponin, cTn)作为心肌细胞的关键调节蛋白，是心肌损伤的重要标志物；脑钠肽(Brain Natriuretic Peptide, BNP)主要由心脏分泌，反映心脏功能及代偿能力。本文综述了肌钙蛋白与脑钠肽的生物学特征及MINS的相关影响因素，并提出联合检测能显著提高MINS诊断的敏感性和特异性。通过同时监测心肌损伤与心功能变化，为临床早期诊断和及时干预提供了有力支持。
Abstract: Myocardial injury after non cardiac surgery (MINS) is a common complication during the perioperative period, and its diagnosis and evaluation are of great significance for improving patient prognosis. Cardiac troponin (cTn), as a key regulatory protein of myocardial cells, its release is an important biomarker of myocardial injury. Brain Natriuretic Peptide (BNP) is mainly secreted by the heart, reflecting cardiac function and compensatory ability. This article reviews the biological characteristics of troponin and brain natriuretic peptide, as well as the related influencing factors of MINS. It proposes that combined detection can significantly improve the sensitivity and specificity of MINS diagnosis. By simultaneously monitoring myocardial injury and changes in heart function, it provides strong support for early clinical diagnosis and timely intervention.
文章引用：任童, 安肖霞. 肌钙蛋白、脑钠肽在非心脏手术后心肌损伤中的诊断价值[J]. 临床医学进展, 2024, 14(10): 1193-1202. https://doi.org/10.12677/acm.2024.14102785

参考文献

[1] Lazar, D.R., Lazar, F., Homorodean, C., Cainap, C., Focsan, M., Cainap, S., et al. (2022) High-Sensitivity Troponin: A Review on Characteristics, Assessment, and Clinical Implications. Disease Markers, 2022, 1-13. [Google Scholar] [CrossRef] [PubMed]
[2] Christianson, R. and Meadors, Q. (2022) The Role of Biomarkers in Chest Pain Evaluation. In: Contemporary Cardiology, Springer, 77-91. [Google Scholar] [CrossRef] 
[3] Li, M.X. and Hwang, P.M. (2015) Structure and Function of Cardiac Troponin C (TNNC1): Implications for Heart Failure, Cardiomyopathies, and Troponin Modulating Drugs. Gene, 571, 153-166. [Google Scholar] [CrossRef] [PubMed]
[4] Katrukha, I.A. (2013) Human Cardiac Troponin Complex. Structure and Functions. Biochemistry (Moscow), 78, 1447-1465. [Google Scholar] [CrossRef] [PubMed]
[5] Canty, J.M. (2022) Myocardial Injury, Troponin Release, and Cardiomyocyte Death in Brief Ischemia, Failure, and Ventricular Remodeling. American Journal of Physiology-Heart and Circulatory Physiology, 323, H1-H15. [Google Scholar] [CrossRef] [PubMed]
[6] Jeremias, A. (2010) The Utility of Troponin Measurement to Detect Myocardial Infarction: Review of the Current Findings. Vascular Health and Risk Management, 2010, 691-699. [Google Scholar] [CrossRef] [PubMed]
[7] Dou, L., Du, Z., Zhu, J. and Wang, T. (2022) Changes and Significance of Serum Troponin in Trauma Patients: A Retrospective Study in a Level I Trauma Center. World Journal of Emergency Medicine, 13, Article 27.
[8] Stark, M., Kerndt, C.C. and Sharma, S. (2024) Troponin. StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK507805/
[9] Campu, A., Muresan, I., Craciun, A., Cainap, S., Astilean, S. and Focsan, M. (2022) Cardiac Troponin Biosensor Designs: Current Developments and Remaining Challenges. International Journal of Molecular Sciences, 23, Article 7728. [Google Scholar] [CrossRef] [PubMed]
[10] Chaulin, A.M. (2022) Biology of Cardiac Troponins: Emphasis on Metabolism. Biology, 11, Article 429. [Google Scholar] [CrossRef] [PubMed]
[11] Chauin, A. (2021) The Main Causes and Mechanisms of Increase in Cardiac Troponin Concentrations Other Than Acute Myocardial Infarction (Part 1): Physical Exertion, Inflammatory Heart Disease, Pulmonary Embolism, Renal Failure, Sepsis. Vascular Health and Risk Management, 17, 601-617. [Google Scholar] [CrossRef] 
[12] Roongsritong, C., Warraich, I. and Bradley, C. (2004) Common Causes of Troponin Elevations in the Absence of Acute Myocardial Infarction. Chest, 125, 1877-1884. [Google Scholar] [CrossRef] [PubMed]
[13] Hall, C. (2004) Essential Biochemistry and Physiology of (NT-pro) BNP. European Journal of Heart Failure, 6, 257-260. [Google Scholar] [CrossRef] [PubMed]
[14] Nishikimi, T. and Nakagawa, Y. (2022) B-Type Natriuretic Peptide (BNP) Revisited—Is BNP Still a Biomarker for Heart Failure in the Angiotensin Receptor/Neprilysin Inhibitor Era? Biology, 11, Article 1034. [Google Scholar] [CrossRef] [PubMed]
[15] Semenov, A.G. and Seferian, K.R. (2011) Biochemistry of the Human B-Type Natriuretic Peptide Precursor and Molecular Aspects of Its Processing. Clinica Chimica Acta, 412, 850-860. [Google Scholar] [CrossRef] [PubMed]
[16] Pandey, K.N. (2021) Molecular Signaling Mechanisms and Function of Natriuretic Peptide Receptor-A in the Pathophysiology of Cardiovascular Homeostasis. Frontiers in Physiology, 12, Article 693099. [Google Scholar] [CrossRef] [PubMed]
[17] Hodes, A. and Lichtstein, D. (2014) Natriuretic Hormones in Brain Function. Frontiers in Endocrinology, 5, Article 201. [Google Scholar] [CrossRef] [PubMed]
[18] Yoshimura, M., Yasue, H. and Ogawa, H. (2001) Pathophysiological Significance and Clinical Application of ANP and BNP in Patients with Heart Failure. Canadian Journal of Physiology and Pharmacology, 79, 730-735. [Google Scholar] [CrossRef] [PubMed]
[19] Goetze, J.P., Bruneau, B.G., Ramos, H.R., et al. (2020) Cardiac Natriuretic Peptides. Nature Reviews Cardiology, 17, 698-717. [Google Scholar] [CrossRef] [PubMed]
[20] Héctor, F.-S., Manuel, R.-Y., Antonio, D.-L., et al. (2017) Heads and Tails of Natriuretic Peptides: Neuroprotective Role of Brain Natriuretic Peptide. Journal of the American Heart Association, 6, Article 7329. [Google Scholar] [CrossRef] 
[21] Oremus, M., McKelvie, R., Don-Wauchope, A., Santaguida, P.L., Ali, U., Balion, C., et al. (2014) A Systematic Review of BNP and NT-Probnp in the Management of Heart Failure: Overview and Methods. Heart Failure Reviews, 19, 413-419. [Google Scholar] [CrossRef] [PubMed]
[22] Wolsk, E., Claggett, B., Diaz, R., Dickstein, K., Gerstein, H.C., Køber, L., et al. (2022) Risk Estimates of Imminent Cardiovascular Death and Heart Failure Hospitalization Are Improved Using Serial Natriuretic Peptide Measurements in Patients with Coronary Artery Disease and Type 2 Diabetes. Journal of the American Heart Association, 11, Article 21327. [Google Scholar] [CrossRef] [PubMed]
[23] Wolsk, E., Claggett, B., Pfeffer, M.A., Diaz, R., Dickstein, K., Gerstein, H.C., et al. (2017) Role of B-Type Natriuretic Peptide and N-Terminal Prohormone BNP as Predictors of Cardiovascular Morbidity and Mortality in Patients with a Recent Coronary Event and Type 2 Diabetes Mellitus. Journal of the American Heart Association, 6, Article 4743. [Google Scholar] [CrossRef] [PubMed]
[24] Jering, K.S., Claggett, B.L., Pfeffer, M.A., Granger, C.B., Køber, L., Lewis, E.F., et al. (2023) Prognostic Importance of NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) Following High-Risk Myocardial Infarction in the PARADISE-MI Trial. Circulation: Heart Failure, 16, Article 259. [Google Scholar] [CrossRef] [PubMed]
[25] Devereaux, P.J. and Szczeklik, W. (2019) Myocardial Injury after Non-Cardiac Surgery: Diagnosis and Management. European Heart Journal, 41, 3083-3091. [Google Scholar] [CrossRef] [PubMed]
[26] Grobben, R.B., van Klei, W.A., Grobbee, D.E. and Nathoe, H.M. (2013) The Aetiology of Myocardial Injury after Non-Cardiac Surgery. Netherlands Heart Journal, 21, 380-388. [Google Scholar] [CrossRef] [PubMed]
[27] Kashlan, B., Kinno, M. and Syed, M. (2024) Perioperative Myocardial Injury and Infarction after Noncardiac Surgery: A Review of Pathophysiology, Diagnosis, and Management. Frontiers in Cardiovascular Medicine, 11, Article 1323425. [Google Scholar] [CrossRef] [PubMed]
[28] Kulkarni, A., Marcucci, M. and Nguyen, J.M.V. (2024) Myocardial Injury after Noncardiac Surgery. Canadian Medical Association Journal, 196, E661. [Google Scholar] [CrossRef] [PubMed]
[29] Gao, L., Chen, L., Wang, B., He, J., Liu, C., Wang, R., et al. (2022) Management of Postoperative Myocardial Injury after Non-Cardiac Surgery in Patients Aged ≥80 Years: Our 10 Years’ Experience. Frontiers in Cardiovascular Medicine, 9, Article 869243. [Google Scholar] [CrossRef] [PubMed]
[30] Devereaux, P.J. and Szczeklik, W. (2019) Myocardial Injury after Non-Cardiac Surgery: Diagnosis and Management. European Heart Journal, 41, 3083-3091. [Google Scholar] [CrossRef] [PubMed]
[31] Ruetzler, K., Smilowitz, N.R., Berger, J.S., Devereaux, P.J., Maron, B.A., Newby, L.K., et al. (2021) Diagnosis and Management of Patients with Myocardial Injury after Noncardiac Surgery: A Scientific Statement from the American Heart Association. Circulation, 144, Article 1024. [Google Scholar] [CrossRef] [PubMed]
[32] Fernando, B., Pablo, A.-C., Matthew, T.V., et al. (2014) Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-Day Outcomes. Anesthesiology, 120, 564-578.
[33] Cao, D., Chandiramani, R., Capodanno, D., Berger, J.S., Levin, M.A., Hawn, M.T., et al. (2020) Non-Cardiac Surgery in Patients with Coronary Artery Disease: Risk Evaluation and Periprocedural Management. Nature Reviews Cardiology, 18, 37-57. [Google Scholar] [CrossRef] [PubMed]
[34] George, R., Menon, V.P., Edathadathil, F., Balachandran, S., Moni, M., Sathyapalan, D., et al. (2018) Myocardial Injury after Noncardiac Surgery—Incidence and Predictors from a Prospective Observational Cohort Study at an Indian Tertiary Care Centre. Medicine, 97, e0402. [Google Scholar] [CrossRef] [PubMed]
[35] Hao, G., Wu, J., Yu, S., Liu, K., Xue, Y., Gong, Q., et al. (2024) Remifentanil vs. Dexmedetomidine for Cardiac Surgery Patients with Noninvasive Ventilation Intolerance: A Multicenter Randomized Controlled Trial. Journal of Intensive Care, 12, Article No. 35. [Google Scholar] [CrossRef] [PubMed]
[36] Bello, C., Rössler, J., Shehata, P., Smilowitz, N.R. and Ruetzler, K. (2023) Perioperative Strategies to Reduce Risk of Myocardial Injury after Non-Cardiac Surgery (MINS): A Narrative Review. Journal of Clinical Anesthesia, 87, Article 111106. [Google Scholar] [CrossRef] [PubMed]
[37] Puelacher, C., Buse, G.L., Seeberger, D., et al. (2018) Perioperative Myocardial Injury after Noncardiac Surgery: Incidence, Mortality, and Characterization. Circulation, 137, 1221-1232.
[38] Yu, S., Zhang, C., Xiong, W., Chen, J., Song, J. and Chen, H. (2021) An Hypothesis: Disproportion between Cardiac Troponin and B-Type Natriuretic Peptide Levels—A High Risk and Poor Prognostic Biomarker in Patients with Fulminant Myocarditis? Heart, Lung and Circulation, 30, 837-842. [Google Scholar] [CrossRef] [PubMed]
[39] Yu, Q. and Yu, S. (2024) The Value of Combined Detection of Serum BNP, Cardiac Troponin-I and Dynamic Electrocardiogram in Early Clinical Diagnosis and Prognosis of Patients with Acute Myocardial Infarction. Discovery Medicine, 36, 598-603. [Google Scholar] [CrossRef] [PubMed]
[40] Deng, L., Liu, X. and Liu, W. (2024) Application Value of Serum Cardiac Troponin T, Brain Natriuretic Peptide Levels and Electrocardiogram Changes in the Treatment and Prognosis Evaluation of Severe Pneumonia in Children. International Journal of General Medicine, 17, 925-934. [Google Scholar] [CrossRef] [PubMed]
[41] Duceppe, E., Borges, F.K., Tiboni, M., Pearse, R., Chan, M.T.V., Srinathan, S., et al. (2020) Association between High-Sensitivity Troponin I And Major Cardiovascular Events after Non-Cardiac Surgery. Journal of the American College of Cardiology, 75, 110. [Google Scholar] [CrossRef] 
[42] Cao, Z., Jia, Y. and Zhu, B. (2019) BNP and NT-proBNP as Diagnostic Biomarkers for Cardiac Dysfunction in Both Clinical and Forensic Medicine. International Journal of Molecular Sciences, 20, Article 1820. [Google Scholar] [CrossRef] [PubMed]

为你推荐