The Journal of Applied Laboratory Medicine: An AACC Publication最新文献

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Heart Fatty Acid Binding Protein for the Diagnosis of Myocardial Ischemia and Infarction 心脏脂肪酸结合蛋白对心肌缺血和梗死的诊断价值

The Journal of Applied Laboratory Medicine: An AACC Publication

Pub Date : 2017-03-29 DOI: 10.1373/JALM.2016.022418

P. Collinson, Jennifer Hersey, R. Bray, D. Gaze, P. Lim, S. Firoozi, A. Ntalianis, F. Boa, A. Prasad

Objective: To establish the analytical performance of a heart fatty acid binding protein (HFABP) method suitable for routine clinical use and examine its role for the diagnosis of myocardial ischemia and myocardial infarction. Methods: Analyses of HFABP were performed on an Advia 2400 (Siemens Healthcare Diagnostics). Imprecision, limit of detection (LOD), limit of blank (LOB), and linearity were assessed using standard methods. Stability was assessed at 4 °C, −20 °C, and with 3 repeated freeze-thaw cycles. Clinical diagnostic performance was assessed using chest pain in patients, with a final diagnosis according to the universal definition of myocardial infarction with cardiac troponin I (cTnI) measured on the Siemens Advia Centaur (cTnI Ultra method, 99th percentile 50 ng/L, 10% CV 30 ng/L). Ischemia was detected using sampling pre- and postangioplasty. Results: LOD and analytical imprecision exceeded the manufacturer9s specification (LOD 1.128 μg/L, 20% CV 1.3 μg/L, 10% CV 2.75 μg/L). Clinical diagnostic efficiency was less than cTnI. Addition of HFABP to cTnI produced a modest increase in diagnostic sensitivity at a cost of significant loss of specificity. Conclusions: Although the test had excellent analytical performance, it did not contribute to the clinical diagnosis of patients with chest pain. HFABP appears to be a marker of myocardial infarction not myocardial ischemia.

目的:建立一种适合临床常规使用的心脏脂肪酸结合蛋白(HFABP)方法的分析性能，并探讨其在心肌缺血和心肌梗死诊断中的作用。方法:在Advia 2400 (Siemens Healthcare Diagnostics)上进行HFABP分析。不精密度、检出限(LOD)、空白限(LOB)和线性采用标准方法进行评价。在4°C、- 20°C和3次重复冻融循环下评估稳定性。通过患者胸痛来评估临床诊断表现，最终诊断依据心肌梗死的通用定义，采用西门子Advia Centaur测量心肌肌钙蛋白I (cTnI Ultra方法，99百分位50 ng/L, 10% CV 30 ng/L)。血管成形术前后通过取样检测缺血。结果:LOD和分析不精密度均超过生产厂家的标准(LOD 1.128 μg/L, 20% CV 1.3 μg/L, 10% CV 2.75 μg/L)。临床诊断效率低于cTnI。将HFABP添加到cTnI中，以显著丧失特异性为代价，产生了诊断敏感性的适度增加。结论:虽然该测试具有良好的分析性能，但它对胸痛患者的临床诊断没有帮助。HFABP似乎是心肌梗死而非心肌缺血的标志。

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The Dilemma of Finding a Young Patient with a Raised Cholesterol Concentration 寻找胆固醇浓度升高的年轻患者的困境

The Journal of Applied Laboratory Medicine: An AACC Publication

Pub Date : 2017-03-01 DOI: 10.1373/JALM.2016.022426

L. Tooth, P. Collinson

K.S., a 26-year-old male, presented to the lipid clinic at St George's Hospital in London with a baseline cholesterol concentration of 8.8 mmol/L (340 mg/dL) and a calculated LDL cholesterol concentration of 7.1 mmol/L (275 mg/L). On clinical examination, there were neither tendon xanthomas nor a family history of hypercholesterolemia or premature death from vascular disease. At this time, K.S. did not meet the Simon Broome criteria (Table 1) for possible familial hypercholesterolemia (FH),2 and because the patient had a body mass index of 31.5 kg/m2 (target <25), lifestyle modification was suggested and a review appointment ordered for 6 months. A carotid intima-medial thickness (CIMT) measurement was ordered to help assess vascular risk. The results showed no plaque, but a right CIMT of 0.6 mm and a left CIMT of 0.7 mm, which were both above the 97.5th percentile for his age and consistent with early atheromatous change.View this table:Table 1. Simon Broome criteria for the diagnosis of FH.aThe following year, his younger brother (aged 23 years) presented with a raised cholesterol concentration of 9.6 mmol/L (371 mg/dL) and a calculated LDL cholesterol concentration of 7.7 mmol/L (298 mg/L). Because the brother had a first-degree relative with raised cholesterol, he met the Simon Broome criteria for possible FH and was investigated …

k.s.， 26岁男性，到伦敦圣乔治医院脂质门诊就诊时，基线胆固醇浓度为8.8 mmol/L (340 mg/dL)，计算LDL胆固醇浓度为7.1 mmol/L (275 mg/L)。在临床检查中，没有肌腱黄瘤，也没有高胆固醇血症的家族史或血管疾病导致的过早死亡。此时，K.S.不符合Simon Broome可能的家族性高胆固醇血症(FH)标准(表1)，2由于患者的体重指数为31.5 kg/m2(目标值<25)，建议改变生活方式并预约6个月的复查。使用颈动脉内膜-内侧厚度(CIMT)测量来帮助评估血管风险。结果显示无斑块，但右侧CIMT为0.6 mm，左侧CIMT为0.7 mm，均高于其年龄的97.5%，与早期动脉粥样硬化改变一致。查看该表:表1。Simon Broome诊断FH的标准。次年，他的弟弟(23岁)出现胆固醇浓度升高9.6 mmol/L (371 mg/dL)，计算LDL胆固醇浓度为7.7 mmol/L (298 mg/L)。因为他的兄弟有一个胆固醇升高的一级亲属，他符合西蒙·布鲁姆(Simon Broome)对可能的FH的标准，并接受了调查……

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