临床本心脏标志物与心脏疾病的实验室诊断-培训课件.pptVIP

参考资料 Richard A. Mcpherson, Matthew R.Pincus. Henry’s Clinical Diagnosis and Management by Laboratory Methods(21st edition). Elevier Inc，2007 丛玉隆.检验医学.人民卫生出版社，2009.2 王建中.实验诊断学.北京大学医学出版社，2003 《冠状动脉疾病和心衰时心脏标志物临床应用建议》（第二版，2006年3月，上海 ） 2008 ESC heart failure guidelines Cardiovascular disease is a multifactorial disease. Metabolic disturbances like hyperlipidemia and hyperglycemia (diabetes) are well known to contribute to disease development; as well some genetic (e.g. familial hypercholesterinemia) and behavioral factors (smoking, physical inactivity) are known to drive the disease process, the final cardiac event being induced by activation of the hemostatic system resulting in thrombotic closure of an atheriosclerotic coronary vessel. New evidence gained in recent years has shown that inflammation is a further process basically involved in the pathomechanism and contributing to cardiovascular disease. Cardiovascular disease usually progresses stepwise. However, it is not mandatory that any cardiac symptoms occur before a (probably fatal) myocardial infarction (MI). Apparently healthy individuals can suddenly experience severe cardiac disease. Determination of risk factors helps to recognize such individuals of high risk, and stratification to a risk lowering preventive therapy. Atherosclerosis is the basis for MI or sudden cardiac death; however, even severe atheroslerosis can be assymtomatic, individuals feeling apparently healthy, but being at high risk nevertheless. If first cardiac symptoms are already present, secondary prevention aims at prevention of a recurrent or more severe event. Again determination of risk factors is applied to stratify the patients at highest risk to the most effective (but usually also most expensive) therapeutic measures. MRFIT (Multiple Risk Factor Intervention Trial) is a prospective primary prevention trial that included nearly 13,000 men aged 35-57 from the US with high risk for CVD (elevated cholesterol or blood pressure,