罗氏诊断指标解读摘要.ppt

PCT可以直观的反应抗生素治疗的效果， 如果抗生素治疗有效，PCT水平会迅速下降至较低水平 如果是非敏感抗生素，PCT水平不会出现下降，会随着疾病的进展逐渐升高 如果更换敏感的抗生素，PCT水平将迅速下降 * * * * Thus, rather than a one-step, “one size fits all” approach for use, the optimal way to consider NT-proBNP is as a continuous variable, across the entire range of diagnostic and prognostic possibilities: for those with very low values (e.g. 300 ng/L) heart failure is very unlikely and prognosis is excellent, while at the other end of the spectrum, higher values are associated with higher likelihood for heart failure, and worse outcomes. For those in the grey zone, the correct diagnosis of heart failure depends on clinical correlation, and outcomes are intermediate. GFR——肾小球滤过率 * * In younger patients, as noted, 125 ng/mL has excellent negative predictive value, which means that for younger patients below this value, the likelihood for heart failure is very low. Breaking the data out in an even more granular manner, younger patients (such as those 50 years) might be better served by a cut-point of 50 ng/L, while in middle aged patients, a cut-point of 75 ng/L may be even more useful than 125 ng/L, however these cut-points are not yet proven. * As with testing in other venues, clinicians need to keep in mind several factors that may affect NT-proBNP values in symptomatic outpatients. 心脏标志物的临床应用可追溯到半个多世纪前。1954年，AST（旧称GOT）作为诊断AMI的第一个心脏标志物用于临床[6]，随后LDH和CK在AMI时的变化引起人们兴趣[7,8]。 十多年后，CK-MB在AMI时的异常变化又得到广泛关注[9]，一度被誉为诊断AMI的“金标准”，并与AST、LDH一起被称为“心肌酶谱”应用于AMI诊断。1979年，WHO会同全世界一些主要心血管学术团体共同制定AMI诊断标准[10]，将心肌相关酶类变化作为诊断要点之一。但此后的大量临床实践发现，CK-MB为主的“心肌酶”的临床特异性和灵敏度并不尽如人意。 二十世纪八十年代末，cTn逐渐步入人们视野。历经大量临床应用研究和几代检测方法（试剂）改进，cTn检测在AMI时的临床特异性和敏感性不断提高，逐步取代CK-MB等，成为诊断AMI的主要心脏标志物。2000年，ESC和ACC联合提出重新定义AMI[11]，其中将cTn的变化作为诊断AMI的重要条件之一。这一观点迅速得到心脏病学专家赞同[12,13]。2007年和2012年，全球心脏病学专家在第三版心肌梗死通用定义中推荐hs-cTn为首选心脏标志物[1,4]。cTn在诊断心肌损伤（包括AMI）中的重要作用得到广泛认同[2,3,14,15] * * 临床上引起cTn检测结果增高的原因有多种。cTn增高提示心肌损伤，心肌损伤的病因应结合临床情况分析[46]。由于检测方法更敏感，应用hs-cTn可使心肌损伤（包括AMI）的诊断提早。以前，临床通常需等约6 h，观察cTn的有意义增高。如今采用高敏感的方法检测cTn，只需 3 h就可