Clinical Significance of Troponin Ic
Troponin ic measurement is mainly used for the laboratory diagnosis of acute myocardial infarction, the prognosis of unstable angina pectoris, and the treatment monitoring of thrombolytic drugs after AMI. At the same time, it has certain diagnostic value for other diseases with myocardial cell damage.
1. The diagnosis of myocardial injury by ctni troponin
Among the many clinical biochemical indicators for the diagnosis of acute myocardial infarction (AMI), CK MB protein was once considered the "gold standard", and has been widely used for many years.
With the in-depth study of cardiac ctni troponin (cTn), the status of CK-MB has been seriously challenged both in terms of myocardial specificity and diagnostic sensitivity. The cTn is considered to be the best definite marker at present, and is gradually replacing CK-MB as the "gold standard" for the diagnosis of AMI. Cardiomyocyte damage is bound to occur in patients with various coronary artery diseases.
The clinical manifestations of some patients may not fully meet the WHO diagnostic criteria for AMI (unstable angina is one of them), but they are accompanied by elevated myocardial injury markers (such as cTnT, etc.), resulting in the leakage of cellular components into the peripheral blood circulation. This makes it possible to detect markers of cardiomyocyte damage.
2. Troponin ic as an indicator of thrombolytic therapy after AMI
Intravenous injection of thrombolytic drugs is a commonly used treatment method for AMI in recent years, and judging whether reperfusion occurs after treatment has also become one of the most concerned issues for clinicians.
There are often bimodal changes in cTnT during reperfusion: on the 1st day, after the infarction is opened, the blood flow enters the lesion site, and the free cTnT is flushed into the blood, and the first peak appears; on the 4th day, the second smaller peak can be observed (mainly from cTnT in the cTn complex). The ratio of these two peaks is helpful for judging whether reperfusion occurs: if the first peak is greater than the second peak, that is, the ratio is greater than 1.0, it often means that reperfusion occurs.
A comparative study of the early kinetics of CK-MB, myoglobin (Mgb), cTnT and cTnI, indicators of early coronary reperfusion, after successful thrombolysis showed that the early kinetics of the four markers released after thrombolysis were basically similar, but the mean index of coronary reperfusion at 90 min was significantly greater for cTnT and cTnI antibody than for CK-MB and Mgb.
3. Troponin ic in the diagnosis of perioperative myocardial infarction
The diagnosis of myocardial infarction after coronary artery bypass grafting plays an important role in cardiac surgery. The cTn is a sensitive and specific marker of perioperative myocardial infarction, which can identify minor perioperative myocardial injury that does not meet the criteria of conventional perioperative myocardial infarction.
4. Troponin ic for the diagnosis of myocarditis
Compared with CK activity, cTnT has higher detection sensitivity in myocarditis due to its relatively high serum detection value and longer rise time, and serum cTnT can be used as a diagnostic marker for acute myocarditis.
5. The relationship between ctni troponin and renal failure
Ischemic heart disease is one of the leading causes of morbidity and mortality in patients with end-stage renal disease, accounting for approximately 40% of total mortality; approximately 25% of these ischemic heart diseases develop AMI. Therefore, in the clinical treatment of patients with advanced renal disease, the diagnosis of cardiovascular complications has become a crucial issue. There are differences in the detection values of cTnT and cTnI in the serum of patients with advanced kidney disease.
6. Differential diagnosis of skeletal muscle injury by ctni troponin
Cardiac and skeletal muscle cells are closely related. During the embryonic period, the two muscles shared many similarities in gene expression, but the expression was different during terminal differentiation. Therefore, the specificity of myocardial injury marker detection in patients with skeletal muscle injury is a matter of concern.
As the second generation cTnT assay has ruled out the cross-reactivity of the assay, cTn can be used as a better marker for the diagnosis of myocardial injury in patients with skeletal muscle injury.
7. Diagnosis of myocardial injury in hypothyroid patients by ctni troponin
Hypothyroidism leads to elevated cholesterol, predisposing patients to coronary artery disease and AMI. At the same time, patients with hypothyroidism often have symptoms of skeletal muscle damage such as cramps and myalgia. Therefore, the serum CK and CK-MB of this kind of patients all increased to varying degrees. At this time, cTn is a better marker for the diagnosis of myocardial injury in hypothyroid patients.
8. Observation of the drug effects by ctni troponin
The cTn is also used to observe the relationship between the pharmacological effects of certain drugs and the heart, to understand whether to improve or exacerbate myocardial ischemia.
