利用生物标志物患者急性心血管疾病课件

1、cp887679- 0 *dr. jaffe is a consultant and receives research support from roche, dade behring and beckmann coulter. he has been or presently is a consultant to ortho diagnostics, sensera, diadexus, abbott, hawaii biotech and tartagen.cp1051812-10.00.51.00306090 120 150 1800.00.51.00306090 120 150 18

2、00.00.51.00306090 120 150 1800.00.51.00306090 120 150 1800.00.51.00306090 120 150 180cp887679- 2cp956024-120102030060120180240300360cp887679- 3100cp887679- 4circulation. 1997;95:2053-2059 cp887679- 5cp887679- 6cp887679- 7cp886232- 783117414813450671.01.83.53.96.27.8risk ratio-0.5-6.71.2-10.61.3-11.7

3、1.7-22.32.6-23.095% ci cp887679- 8cp1099500-8jacc 41:376, 20036-modeath/mi raten=262st-depressionp=0.20n=125n=259n=174n=57n=82p=0.13p=0.15troponintroponin+cp887679- 9cp1142356-17james et al: am j med 115:181, 200314121086420p=0.04p=0.01p=0.15p0.001p0.001p0.0011180177430616652111147620138626580932874

4、64306441,992 5,1232,563 4,5523,446 3,679cp887679- 100.010.020.030.040.050.060.0abcdeghtotal cv, %acs180centaurimmuno 1accessaccess2vidasliaisonrxl csopusimmulitealpha dxeciaia 21ifcc precision study(clinical chem 2004)cp887679- 11or 4.55; 2.66-7.78rapid troponin i assaycp1148152-9int j cardiol 93:11

5、3, 2004%negdeathmideath or mi569892130132205troponin t (0.1 g/l)troponin t (0.01 g/l)or 1.80; 1.30-2.541.82; 1.38-2.401.64; 1.31-2.06or 3.20; 2.22-4.592.26; 1.79-2.851.47; 1.12-1.933.42; 2.57-5.984.29; 3.02-6.09pos%4115113139862513619711636221301cp887679- 12assay positive wbdsa negative wbdsa totalb

6、eckman 10% cv+ 17 20 37- 11 106 117roche 10% cv+ 16 8 24- 12 118 130beckman 99th%+ 20 38 58- 8 88 96roche 99th% + 21 44 65- 7 82 89cp887679- 13cp1131968-3revascularizationmyeloperoxidase quartile 2myeloperoxidase quartile 3myeloperoxidase quartile 4major adverse cardiac eventsmyeloperoxidase quartil

7、e 2myeloperoxidase quartile 3myeloperoxidase quartile 4cp887679- 14cp1132618-7cp887679- 15cp1104508-19cp887679- 16ahj 148:577, 2004cp1176222-20 min30 min60 min90 minsensitivity2 hr3 hr6 hr6 hrspecificity cp887679- 17cp1179389-5tnt (0.01)prog cardiovasc dis 47(3), 2004p0.01)p=0.02thrombus (%)p=0.03tf

8、g 0/1 (%)p 98.6 98.677.0-98.577.0-98.558.4-76.958.4-76.94.7-58.34.7-58.3death or mi %death or mi %25252020151510105 50 025252020151510105 50 0cp887679- 22cp1019654-1pt with event (%)relative risk (95% ci)clopidogrelbetterplacebobettercp887679- 23cp1189452-4cfcdrisglcccp887679- 24cfcdrisglcccp1189452

9、-5cp887679- 25probnpserin protease(corin?)mair: scand j clin lab invest, 1999cp1189452-10cp887679- 26cp1189452-2097.5%percentile(pg/ml)age groupsmalesfemalescp887679- 27ahj 149(4), april 2005cp1189452-21cp887679- 2838 4bnpconcentration(pg/ml)diagnosisn=1391,076 138no chfcp1189452-25n=97chflv dysfunc

10、tionno acute chfn=14141 31cp887679- 29medianbnp level(pg/ml)cp1189452-26bnp levels in normal subjects and inpatientswith heart failurenormaliiiiiiivclasscp887679- 30cp1189452-27ed probability of chf recordedp0.0001 from clinical judgment to combinedmccullough pa et al: circulation 106:416, 2002diagn

11、ostic accuracy (%)clinicaljudgmentbnpcombined74.081.281.5n=1,538cp887679- 31n=1,586; 50% chf; 56% male;6417 yo; 41% copd; 30% hx chfcp1189452-28auc = 0.91cp887679- 32ajc 95, april 15, 2005cp1189452-30cp887679- 33mccullough pa et al for the bnp multinational study investigators: j am coll cardiol 41:

12、278a, 2003application of bnp testing in chf“grey zone” bnpbnp (pg/ml)“grey zone” bnp100-500 pg/ml26.4% of all cases16.5%chf7.9%no chf0100200300400500600700800900 1,000 1,100 1,200 1,300cp1189452-31cp887679- 34cp1189452-32cp887679- 35cp1189452-33cp887679- 36cp1189452-34cp887679- 371.21.85.08.40123456

13、7891030 days6 months%p 0.0001p = 0.9baseline bnp & clinical outcomes p 0.0001p = 0.9deathmi3.85.24.15.301234567891030 days6 months%bnp 80n = 1356n = 320morrow da jacc 2004 cp887679- 38cp1173030-6*p250 ng/l250 ng/l0.1 g/lnt-probnptroponin tdeath, myocardial infarction (%)*cp887679- 39death/mi at 6 mo

14、nthstest for interaction:p=ns%bnp negbnp cut point = 80 pg/mlcp1189452-45consinvbnp pos(19% bnp pos)morrow da: jacc, 2004cp887679- 40luchner a et al: jacc 32:1839, 1998pg/mlpmol/mlanp 32%bnp 89%cgmp 18%n=592n=80p0.01p0.01p0.01no b b-blocker (n=592)b b-blocker (n=80)cp1189452-59cp887679- 41cp1143360-10circ 109:584, 2004deathor mi(%)femal