{"id":16964,"date":"2019-04-09T05:24:36","date_gmt":"2019-04-08T21:24:36","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=16964"},"modified":"2019-06-02T06:38:06","modified_gmt":"2019-06-01T22:38:06","slug":"bmj%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87-%e4%bd%8f%e9%99%a2%e6%82%a3%e8%80%85%e9%ab%98%e6%95%8f%e5%bf%83%e8%84%8f%e8%82%8c%e9%92%99%e8%9b%8b%e7%99%bd%e7%9c%9f%e6%ad%a3%e7%9a%8499%e7%99%be%e5%88%86","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=16964","title":{"rendered":"[BMJ\u53d1\u8868\u8bba\u6587]: \u4f4f\u9662\u60a3\u8005\u9ad8\u654f\u5fc3\u810f\u808c\u9499\u86cb\u767d\u771f\u6b63\u768499\u767e\u5206\u4f4d\uff1a\u4e00\u9879\u524d\u77bb\u89c2\u5bdf\u961f\u5217\u7814\u7a76"},"content":{"rendered":"\n

Research<\/strong><\/h3>\n\n\n\n

True 99th centile of high sensitivity cardiac troponin for hospital patients: prospective, observational cohort study<\/h1>\n\n\n\n

Mark Mariathas, Rick Allan, Sanjay Ramamoorthy, et al<\/h3>\n\n\n\n

BMJ<\/em> 2019;364:l729<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

Objective<\/strong>\u00a0\u76ee\u7684<\/h2>\n\n\n\n

To determine the distribution, and specifically the true 99th centile, of high sensitivity cardiac troponin I (hs-cTnI) for a whole hospital population by applying the hs-cTnI assay currently used routinely at a large teaching hospital.<\/p>\n\n\n\n

\u91c7\u7528\u5927\u578b\u6559\u5b66\u533b\u9662\u76ee\u524d\u4f7f\u7528\u7684\u9ad8\u654f\u5fc3\u810f\u808c\u9499\u86cb\u767dI (hs-cTnI)\u5206\u6790\u65b9\u6cd5\uff0c\u786e\u5b9a\u5168\u90e8\u4f4f\u9662\u4eba\u7fa4hs-cTnI\u7684\u5206\u5e03\u53ca\u771f\u6b63\u768499\u767e\u5206\u4f4d\u3002<\/p>\n\n\n\n

Design<\/strong>\u00a0\u8bbe\u8ba1<\/h2>\n\n\n\n

Prospective, observational cohort study.<\/p>\n\n\n\n

\u524d\u77bb\u3001\u89c2\u5bdf\u6027\u961f\u5217\u7814\u7a76<\/p>\n\n\n\n

Setting<\/strong>\u00a0\u573a\u666f<\/h2>\n\n\n\n

University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom, between 29 June 2017 and 24 August 2017.<\/p>\n\n\n\n

\u82f1\u56fd\u5357\u5b89\u666e\u987fNHS Foundation Trust\u5357\u5b89\u666e\u987f\u5927\u5b66\u533b\u96622017\u5e746\u670829\u65e5\u81f38\u670824\u65e5\u3002<\/p>\n\n\n\n

Participants<\/strong>\u00a0\u7814\u7a76\u5bf9\u8c61<\/h2>\n\n\n\n

20\u2009000 consecutive inpatients and outpatients undergoing blood tests for any clinical reason. Hs-cTnI concentrations were measured in all study participants and nested for analysis except when the supervising doctor had requested hs-cTnI for clinical reasons.<\/p>\n\n\n\n

\u56e0\u4efb\u4f55\u4e34\u5e8a\u539f\u56e0\u63a5\u53d7\u8840\u6db2\u68c0\u67e5\u768420000\u540d\u8fde\u7eed\u7684\u4f4f\u9662\u53ca\u95e8\u8bca\u60a3\u8005\u3002\u5bf9\u6240\u6709\u7814\u7a76\u5bf9\u8c61\u6d4b\u5b9ahs-cTnI\u6c34\u5e73\uff0c\u9664\u4e34\u5e8a\u533b\u751f\u7531\u4e8e\u4e34\u5e8a\u539f\u56e0\u8981\u6c42\u68c0\u67e5hs-cTnI\u4e4b\u5916\uff0c\u5176\u4f59\u7ed3\u679c\u5747\u7eb3\u5165\u5206\u6790\u3002<\/p>\n\n\n\n

Main outcome measures<\/strong>\u00a0\u4e3b\u8981\u7814\u7a76\u7ed3\u5c40<\/h2>\n\n\n\n

Distribution of hs-cTnI concentrations of all study participants and specifically the 99th centile.<\/p>\n\n\n\n

\u6240\u6709\u7814\u7a76\u5bf9\u8c61hs-cTnI\u6c34\u5e73\u5206\u5e03\u53ca\u517699\u767e\u5206\u4f4d\u3002<\/p>\n\n\n\n

Results<\/strong>\u00a0\u7ed3\u679c<\/h2>\n\n\n\n

The 99th centile of hs-cTnI for the whole population was 296 ng\/L compared with the manufacturer\u2019s quoted level of 40 ng\/L (currently used clinically as the upper limit of normal; ULN). Hs-cTnI concentrations were greater than 40 ng\/L in one in 20 (5.4%, n=1080) of the total population. After excluding participants diagnosed as having acute myocardial infarction (n=122) and those in whom hs-cTnI was requested for clinical reasons (n=1707), the 99th centile was 189 ng\/L for the remainder (n=18\u2009171). The 99th centile was 563 ng\/L for inpatients (n=4759) and 65 ng\/L for outpatients (n=9280). Patients from the emergency department (n=3706) had a 99th centile of 215 ng\/L, with 6.07% (n=225) greater than the recommended ULN. 39.02% (n=48) of all patients from the critical care units (n=123) and 14.16% (n=67) of all medical inpatients had an hs-cTnI concentration greater than the recommended ULN.<\/p>\n\n\n\n

\u5168\u90e8\u4eba\u7fa4hs-cTnI\u768499\u767e\u5206\u4f4d\u4e3a296 ng\/L\uff0c\u5382\u5bb6\u5efa\u8bae\u7684\u53c2\u8003\u503c\u4e3a40 ng\/L\uff08\u5373\u76ee\u524d\u4e34\u5e8a\u4f7f\u7528\u7684\u6b63\u5e38\u503c\u4e0a\u9650\uff1bULN\uff09\u3002\u5168\u90e8\u4eba\u7fa4\u4e2d\u7ea61\/20 (5.4%, n = 1080)\u7684hs-cTnI\u6c34\u5e73\u8d85\u8fc740 ng\/L\u3002\u6392\u9664\u8bca\u65ad\u4e3a\u6025\u6027\u5fc3\u808c\u6897\u6b7b(n=122)\u53ca\u5176\u4ed6\u4e34\u5e8a\u539f\u56e0\u6d4b\u5b9ahs-cTnI (n=1707)\u7684\u60a3\u8005\u540e\uff0c\u5176\u4f59\u4eba\u7fa4(n=18\u2009171)\u768499\u767e\u5206\u4f4d\u6570\u4e3a189 ng\/L\u3002\u4f4f\u9662\u60a3\u8005 (n=4759)\u768499\u767e\u5206\u4f4d\u6570\u4e3a563 ng\/L\uff0c\u95e8\u8bca\u60a3\u8005(n=9280)\u768499\u767e\u5206\u4f4d\u6570\u4e3a65 ng\/L\u3002\u6025\u8bca\u79d1\u60a3\u8005(n=3706)\u768499\u767e\u5206\u4f4d\u6570\u4e3a215 ng\/L\uff0c6.07%\u7684\u60a3\u8005(n=225)\u8d85\u8fc7\u63a8\u8350\u7684ULN\u3002\u76d1\u62a4\u75c5\u623f39.02%\u7684\u60a3\u8005(n=48)\u4ee5\u53ca14.16%\u7684\u5185\u79d1\u4f4f\u9662\u60a3\u8005(n=67)\u5176hs-cTnI\u6c34\u5e73\u8d85\u8fc7\u63a8\u8350\u7684ULN\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n

Table 1<\/strong>Baseline characteristics stratified by hs-cTnI levels (ng\/L) less than or greater than ULN <\/p>\n\n\n\n
<\/td>Hs-cTnI <ULN
(n=18\u2009915)<\/th>		Hs-cTnI >ULN
(n=1085)<\/th>		P value<\/th><\/tr><\/thead>
Age (years)<\/td>57.4<\/td>74.2<\/td><0.001<\/td><\/tr>
Male sex (No, %)<\/td>8796 (46.5)<\/td>622 (57.3)<\/td>0.005<\/td><\/tr>
eGFR(mL\/min\/1.73 m2<\/sup>) <\/td>79.1<\/td>59.6<\/td><0.001<\/td><\/tr>
Sodium (mmol\/L)<\/td>137.2<\/td>136<\/td><0.001<\/td><\/tr>
Inpatients (No, %)<\/td>4540 (24.0)<\/td>405(37.3)<\/td><0.001<\/td><\/tr>
Outpatients (No, %)<\/td>9155(48.4)<\/td>189(17.4)<\/td><0.001<\/td><\/tr><\/tbody><\/table>\n\n\n\n

eGFR=estimated glomerular filtration rate; hs-cTnI=high sensitivity cardiac troponin I; ULN=upper limit of normal (40 ng\/L).<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions<\/strong>\u00a0\u7ed3\u8bba<\/h2>\n\n\n\n

Of 20\u2009000 consecutive patients undergoing a blood test for any clinical reason at our hospital, one in 20 had an hs-cTnI greater than the recommended ULN. These data highlight the need for clinical staff to interpret hs-cTnI concentrations carefully, particularly when applying the recommended ULN to diagnose acute myocardial infarction, in order to avoid misdiagnosis in the absence of an appropriate clinical presentation.<\/p>\n\n\n\n

\u5728\u6211\u4eec\u533b\u9662\u56e0\u4efb\u4f55\u4e34\u5e8a\u539f\u56e0\u63a5\u53d7\u8840\u6db2\u68c0\u67e5\u768420000\u540d\u8fde\u7eed\u60a3\u8005\u4e2d\uff0c1\/20\u7684hs-cTnI\u6c34\u5e73\u8d85\u8fc7\u63a8\u8350\u7684UNL\u3002\u8fd9\u4e9b\u6570\u636e\u8868\u660e\uff0c\u5728\u6ca1\u6709\u76f8\u5e94\u4e34\u5e8a\u8868\u73b0\u65f6\uff0c\u4e3a\u907f\u514d\u8bef\u8bca\uff0c\u4e34\u5e8a\u533b\u751f\u9700\u8981\u4ed4\u7ec6\u89e3\u8bfbhs-cTnI\u7684\u68c0\u67e5\u7ed3\u679c\uff0c\u5c24\u5176\u662f\u4f7f\u7528\u63a8\u8350\u7684ULN\u8bca\u65ad\u6025\u6027\u5fc3\u808c\u6897\u585e\u65f6\u3002<\/p>\n\n\n\n

Trial registration<\/strong>\u00a0\u8bd5\u9a8c\u6ce8\u518c<\/h2>\n\n\n\n

Clinicaltrials.gov NCT03047785<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

Research True 99th centile of high sensitivity cardiac […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/16964"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=16964"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/16964\/revisions"}],"predecessor-version":[{"id":16975,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/16964\/revisions\/16975"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=16964"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=16964"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=16964"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}