循環器ジャーナル66巻4号

2018年10月発行

特集 循環器救急の最前線—初期診療と循環管理を極める Ⅲ．初期診療に必須の検査と処置をマスターする

心血管バイオマーカー

著者： 清野精彦¹

所属機関： ¹日本医科大学千葉北総病院

ページ範囲：P.532 - P.537

Point
・冠動脈疾患の早期診断，リスク層別化には心筋トロポニン，H-FABPが重要．
・不安定プラーク関連マーカーに関する知見が興味深い．
・心不全の診断，重症度・予後評価にはBNP，NT-proBNPが重要．
・心不全でもトロポニンにより微小心筋傷害が検出され，予後指標に該当．
・肺血栓塞栓症や急性大動脈解離の除外診断にはDダイマーが有用．

参考文献

1) Seino Y, Ogata K, Takano T, et al:Use of whole blood rapid panel test for heart-type fatty acid-binding protein in patients with acute chest pain-comparison with rapid troponin T and myoglobin tests. Am J Med 115:185-190, 2003

2) Kitamura M, Hata N, Takayama T, et al:High-sensitivity cardiac troponin T for earlier diagnosis of acute myocardial infarction in patients with initially negative troponin T test-Comparison between cardiac markers. J Cardiol 7:490-496, 2013

3) Kitamura M, Hata N, Takayama T, et al:Different characteristics of cardiac biomarkers to decide and predict the culprit lesions in patients with suspicious acute coronary syndrome. Heart and Vessel 31:907-909, 2016

4) Thygesen K, Alpert JS, Jaffe AS, et al:Third universal definition of myocardial infarction. J Am Coll Cardiol 60:1581-1598, 2012

5) Newby LK, Jesse RL, Babb JD, et al:ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations:a report of the American College of Cardiology Foundation task force on clinical expert consensus documents. J Am Coll Cardiol 60:2427-2463, 2012

6) 日本循環器学会：急性・慢性心不全診療ガイドラインJCS2017/JHFS 2017

7) Porapakkham P, Porapakkham P, Zimmet H, et al:B-type natriuretic peptide-guided heart failure therapy. A meta-analysis. Arch Intern Med 170:507-551, 2010

8) Felker GM, Hasselblad V, Hernandez AF, O'Connor CM:Biomarker-guided therapy in chronic heart failure:a meta-analysis of randomized controlled trials. Am Heart J 158:422-430, 2009

9) Setsuta K, Seino Y, Takahashi N, et al:Clinical significance of elevated levels of cardiac troponin T in patients with chronic heart failure. Am J Cardiol 84:608-611, 1999

10) Setsuta K, Seino Y, Ogawa T, et al:Use of cytosolic and myofibril markers in the detection of ongoing myocardial damage in patients with chronic heart failure. Am J Med 113:717-722, 2002

11) Latini R, Masson S, Anand IS, et al:Prognostic value of very low plasma concentration of troponin T in patients with stable chronic heart failure. Circulation 116:1242-1249, 2007

12) Otsuka T, Kawada T, Ibuki C, Seino Y:Association between high-sensitivity cardiac troponin T levels and the predicted cardiovascular risk in middle-aged men without overt cardiovascular disease. Am Heart J 159:972-978, 2010

13) Tajika K, Okamatsu K, Takano M, et al:Malondialdehyde-modified low-density lipoprotein is a useful marker to identify patients with vulnerable plaque. Circ J 76:2211-2217, 2012

14) Hayashida K, Kume N, Murase T, et al:Serum soluble lectin-like oxidized low-density lipoprotein receptor-1 levels are elevated in acute coronary syndrome:a novel marker for early diagnosis. Circulation 112:812-818, 2005

15) Kobayashi N, Takano M, Hata N, et al:Soluble lectin-like oxidized LDL receptor-1（sLOX-1）as a valuable diagnostic marker for rupture of thin-cap fibroatheroma:verification by optical coherence tomography. Int J Cardiol 168:3217-3223, 2013

16) Becattini C, Vedovati MC, Agnelli G:Prognostic value of troponins in acute pulmonary embolism:a meta-analysis. Circulation 116:427-433, 2007

17) Puls M, Dellas C, Lankeit M, et al:Heart-type fatty acid-binding protein permits early risk stratification of pulmonary embolism. Eur Heart J 28:224-229, 2007