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高敏肌钙蛋白有助于评估心血管病风险！JAMA研究称指南有缺陷

2020-08-12 朱朱 中国循环杂志

心血管高敏肌钙蛋白
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对于动脉粥样硬化性心血管病（以下简称心血管病）患者，2018年美国胆固醇管理指南根据心血管事件及高危因素（下图），将其分为极高危和非极高危两个组，并采用不同的降脂治疗策略。

对于动脉粥样硬化性心血管病（以下简称心血管病）患者，2018年美国胆固醇管理指南根据心血管事件及高危因素（下图），将其分为极高危和非极高危两个组，并采用不同的降脂治疗策略。
 

然而，8月5日JAMA心脏病学子刊在线发表的一项研究表明，该指南对心血管病患者的心血管风险评估方法存在缺陷，应将高敏肌钙蛋白水平纳入其中。
 
研究者发现，将高敏肌钙蛋白水平加入到指南提出的心血管风险评估方法中后，可明显改善对心血管病患者的风险分层，具体表现在于，可将11.9%的患者重新分入到更合适的组别，从而接受更合适的降脂治疗。
 
研究者认为，在评估心血管病患者未来的心血管风险时，应考虑高敏肌钙蛋白水平，这样可优化心血管患者的二级预防治疗。
 
该研究显示，在2018年美国胆固醇管理指南评估的非极高危心血管病患者中，高敏肌钙蛋白I水平超过6 ng/L（风险阈值）的患者中3年心血管事件的发生率（9.1%）与极高危患者（8.8%）一样。
 
而在指南界定的极高危患者中，高敏肌钙蛋白I水平低于检测下限（<2 ng/L）的患者中心血管事件的发生率（2.7%）与非极高危患者（5%）相似。
 
根据临床标准评估的极高危心血管病患者中3年心血管事件发生风险是非极高危患者的2倍。
 
加入高敏肌钙蛋白水平后，11.9%的心血管病患者重新归类，其中，9.1%（1/11）的极高危患者和25%的非极高危患者被重新分类。
 
在极高危心血管病患者中，高敏肌钙蛋白I水平低于检测下限者占9%。在非极高危患者中，高敏肌钙蛋白I水平>6 ng/L者占22.6%。
 
该研究纳入PEGASUS-TIMI 54研究中8635例患者，所有患者在纳入前1~3年发生心肌梗死，至少50岁，至少有1个高危因素。患者的平均年龄为65岁，76.6%为男士。
 
来源：Clinical Application of High-Sensitivity Troponin Testing in the Atherosclerotic Cardiovascular Disease Framework of the Current Cholesterol Guidelines. JAMA Cardiol. Published online August 5, 2020.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1644857, encodeId=8be1164485eb2, content=<a href='/topic/show?id=e3eb89e17fb' target=_blank style='color:#2F92EE;'>#血管病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89717, encryptionId=e3eb89e17fb, topicName=血管病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=64bb23195917, createdName=Luyuxie_17, createdTime=Wed Dec 30 16:36:20 CST 2020, time=2020-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=918577, encodeId=9bf69185e741, content=涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6fdc5454569, createdName=佛系小咸鱼, createdTime=Wed Jan 20 23:28:01 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=811425, encodeId=1c648114258d, content=<a href='/topic/show?id=1b72102420dd' target=_blank style='color:#2F92EE;'>#高敏肌钙蛋白#</a>有助于评估<a href='/topic/show?id=974e51e2810' target=_blank style='color:#2F92EE;'>#心血管#</a>风险，对于正常高限的肌钙蛋白，同样预示着可能潜在的风险, beContent=null, objectType=article, channel=null, level=null, likeNumber=287, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102420, encryptionId=1b72102420dd, topicName=高敏肌钙蛋白), TopicDto(id=51728, encryptionId=974e51e2810, topicName=心血管)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Thu Aug 20 14:44:26 CST 2020, time=2020-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036218, encodeId=2bb11036218e0, content=顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Wed Aug 12 15:36:20 CST 2020, time=2020-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=808188, encodeId=f27c808188ca, content=学到了, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c2e5279157, createdName=1483c61am76暂无昵称, createdTime=Wed Aug 12 12:47:04 CST 2020, time=2020-08-12, status=1, ipAttribution=)]
    2020-12-30 Luyuxie_17

    #血管病#

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1644857, encodeId=8be1164485eb2, content=<a href='/topic/show?id=e3eb89e17fb' target=_blank style='color:#2F92EE;'>#血管病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89717, encryptionId=e3eb89e17fb, topicName=血管病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=64bb23195917, createdName=Luyuxie_17, createdTime=Wed Dec 30 16:36:20 CST 2020, time=2020-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=918577, encodeId=9bf69185e741, content=涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6fdc5454569, createdName=佛系小咸鱼, createdTime=Wed Jan 20 23:28:01 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=811425, encodeId=1c648114258d, content=<a href='/topic/show?id=1b72102420dd' target=_blank style='color:#2F92EE;'>#高敏肌钙蛋白#</a>有助于评估<a href='/topic/show?id=974e51e2810' target=_blank style='color:#2F92EE;'>#心血管#</a>风险，对于正常高限的肌钙蛋白，同样预示着可能潜在的风险, beContent=null, objectType=article, channel=null, level=null, likeNumber=287, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102420, encryptionId=1b72102420dd, topicName=高敏肌钙蛋白), TopicDto(id=51728, encryptionId=974e51e2810, topicName=心血管)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Thu Aug 20 14:44:26 CST 2020, time=2020-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036218, encodeId=2bb11036218e0, content=顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Wed Aug 12 15:36:20 CST 2020, time=2020-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=808188, encodeId=f27c808188ca, content=学到了, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c2e5279157, createdName=1483c61am76暂无昵称, createdTime=Wed Aug 12 12:47:04 CST 2020, time=2020-08-12, status=1, ipAttribution=)]
    2021-01-20 佛系小咸鱼

    涨知识

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  3. [GetPortalCommentsPageByObjectIdResponse(id=1644857, encodeId=8be1164485eb2, content=<a href='/topic/show?id=e3eb89e17fb' target=_blank style='color:#2F92EE;'>#血管病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89717, encryptionId=e3eb89e17fb, topicName=血管病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=64bb23195917, createdName=Luyuxie_17, createdTime=Wed Dec 30 16:36:20 CST 2020, time=2020-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=918577, encodeId=9bf69185e741, content=涨知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6fdc5454569, createdName=佛系小咸鱼, createdTime=Wed Jan 20 23:28:01 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=811425, encodeId=1c648114258d, content=<a href='/topic/show?id=1b72102420dd' target=_blank style='color:#2F92EE;'>#高敏肌钙蛋白#</a>有助于评估<a href='/topic/show?id=974e51e2810' target=_blank style='color:#2F92EE;'>#心血管#</a>风险，对于正常高限的肌钙蛋白，同样预示着可能潜在的风险, beContent=null, objectType=article, channel=null, level=null, likeNumber=287, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102420, encryptionId=1b72102420dd, topicName=高敏肌钙蛋白), TopicDto(id=51728, encryptionId=974e51e2810, topicName=心血管)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Thu Aug 20 14:44:26 CST 2020, time=2020-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036218, encodeId=2bb11036218e0, content=顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Wed Aug 12 15:36:20 CST 2020, time=2020-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=808188, encodeId=f27c808188ca, content=学到了, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c2e5279157, createdName=1483c61am76暂无昵称, createdTime=Wed Aug 12 12:47:04 CST 2020, time=2020-08-12, status=1, ipAttribution=)]
    2020-08-20 lovetcm

    #高敏肌钙蛋白#有助于评估#心血管#风险，对于正常高限的肌钙蛋白，同样预示着可能潜在的风险

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    2020-08-12 旺医

    顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息

    0

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    2020-08-12 1483c61am76暂无昵称

    学到了

    0

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他汀类药物广泛用于心血管病一级和二级预防，但少数患者在使用他汀的过程中会出现肌病，有些患者甚至不能忍受而停药。在用辛伐他汀的患者中，肌病的发生率很低，为9例/万人年，但肌病风险的个体差异可高达34倍。