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心脏标志物(第2版)

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《心脏标志物(第2版)》为第2版,增加了不少新内容,特别对临床和检验界关注的BNP检测,进行了较详尽的介绍。不仅对检验医师,对心血管医师、急诊医师都是一本很有价值的参考书和工具书,原书在国外备受推崇。鉴于国内少见类似著作,《心脏标志物(第2版)》的出版有其独特的价值。近十余年来,心脏标志物领域有了飞速的发展,出现一系列新的标志物,推动了心血管疾病诊断水平的提高,尤其是心脏特异肌钙蛋白的检测促使临床上提出急性冠脉综合征(ACS)的新概念,推动建立诊断急性心肌梗死的新标准。同时引入了危险分层的概念,协助临床制订治疗方案。Wu博士是这方面的专家和先行者,书写多篇有影响的论著和综述,并编著出版了《心脏标志物》第1版。
Catalogue

第一部分 心脏标志物的临床应用
第一章 胸痛门诊早期检测心肌损伤的血清生化标志物应用规范
第二章 急性冠脉综合征的处理
第三章 心脏标志物在临床试验中的发展演变
第四章 应用生化标志物评估再灌注和预测梗死面积——实践与希望
第五章 心脏标志物检测化疗药物引起的心肌损伤
第六章 生物标志物在心脏外科手术后诊断和预后方面的应用

第二部分 心肌肌钙蛋白的临床应用
第七章 通过蛋白修饰提高肌钙蛋白诊断能力
第八章 肾衰竭和骨骼肌疾病患者心肌肌钙蛋白的测定
第九章 心肌特异性肌钙蛋白在非缺血性心脏病中的应用

第三部分 心脏标志物的分析
第十章 心肌肌钙蛋白测定中抗体选择策略
第十一章 心肌肌钙蛋白免疫测定的影响因素
第十二章 心脏标志物的即时检验
第十三章 心脏标志物的标准化
第十四章 心脏标志物判断值的分析和进展

第四部分 心肌缺血的早期标志和危险分层
第十五章 心肌缺血标志物在急性冠脉综合征早期诊断中的应用
第十六章 缺血修饰清蛋白、游离脂肪酸、全血胆碱、B型钠尿肽、糖原磷酸化酶BB和心肌钙蛋白
第十七章 C-反应蛋白对一级危险的评估
第十八章 血浆高敏C-反应蛋白在急性冠状动脉综合征中的预测价值
第十九章 影响C-反应蛋白检测的分析前和分析中因素
第二十章 脂肪酸结合蛋白——心肌缺血及危险分层的早期血浆标志物
第二十一章 氧化型低密度脂蛋白和丙二醛-修饰低密度脂蛋白在冠心病患者中的应用

第五部分 充血性心衰的心脏标志
第二十二章 心力衰竭的病理生理学
第二十三章 B型钠尿肽:生物化学和检测
第二十四章 B型钠尿肽在诊断和处理充血性心力衰竭中的作用
第二十五章 B型钠尿肽监测治疗成效
第二十六章 B型氨基端钠尿肽原(NT-pro-BNP)

第六部分 感染和遗传因素在心脏病中的作用
第二十七章 感染在动脉粥样硬化和急性冠状动脉综合征发病中的作用
第二十八章 与急性冠脉综合征和心衰相关的基因多态性基因组药理学的目标
索引
Book Abstract

不稳定型心绞痛的再定义
WHO关于MI的定义采用了CK和CK-MB数值,在上述的各种文献中广为应用。这一标准仍有效提供人群危险度分层,在临床试验中用于定义特定终点。随着对Acs病理生理机制更深入的了解,WHO诊断MI标准的局限性越发明显。尽管WHO定义通过系列血清学标志水平升高或降低明确的区分MI确诊和疑似病例,但不同研究升高或降低程度的确定标准各异,限制了这些结果的汇总分析和整体理解。并且,早期的是或不是模式的两元分层无法用于UA患者的危险度梯度分析。这也就难怪有一段时间对于可检测标志测量值的意义,在文献中出现混乱且常常互相矛盾。
众多研究者尝试以危险度分层将患者分为预定的亚组,如年龄、性别、疼痛特点和其他伴发病症。就诊时ECG中ST段的改变长久以来都被认为可预测更高频率的远期心脏意外事件。综合多年的临床资料,Braumwald于1989年提出UA临床分类建议。Braunwald分类系统取决于3项因素:症状严重程度、临床表现和ECG发现。1994年,国家指南使此定义更为精确,将患者分为3个危险度组别(低危、中危和高危)以期引入靶向治疗并决定适当的后续医疗措施。在高危组越来越强调尽早、积极抗缺血的重要性。因此,确定最适合接受治疗的患者愈发重要。于这一论述最贴切的就是Braunwald定义系统和随后的指南文件为进一步的临床研究入选患者提供了准确依据。
在随后的众多临床试验中均证实了Braunwald分类系统的正确性,包括同冠状动脉造影明确的疾病严重度的高度相关性。此外,越来越多的证据证实UA、NSTEMI和ST段抬高性心肌梗死(sTEMI)均与冠状动脉血流不同程度的急剧减少相关,而这一证据也进一步支持不稳定冠状动脉病变患者危险度分层的观念。冠状动脉血流动态和反复的减少的过程其机制是动脉粥样硬化斑块破裂导致不同数量红细胞、纤维蛋白和血小板形成血栓。这些早期的指南仅强调使用生物标志协助UA危险度分层,这反映了当时技术的局限性以及对Acs复杂程度理解的局限性。CK-MB地位的演化
从20世纪60年代至今,CK-MB同工酶被认为是诊断AMI的“金标准”。在历史上CK-MB以电泳和酶促分析的方法测定,其参考值区间取决于所采用的技术方法。对于基于酶活性的化验方法(电泳和柱色谱法),正常值上限(ULN)变动于10~20U/L;对于免疫测定法(质量测量),ULN通常变动于5~10ng/m1。单克隆抗体技术的出现,使CK-MB的检测更加敏感和准确,该方法也成为心肌损伤生物化学测量的标准。但是,AMI的诊断不仅需要CK-MB水平升高,还需要CK水平升高超过ULN的2~3倍。这些标准一直应用于临床近30年。
Introduction

心血管疾病严重威胁人类健康,一直是世界医学界关注的焦点。人们竭尽全力,期望提高对多种心脏病。特别是冠心病的诊断、预测水平,以指导治疗,提高疗效,降低死亡率。
经过几十年的努力,冠心病死亡率逐年下降,特别是近十年来,在心血管疾病诊断上有一系列重大的进展,肌钙蛋白、肌红蛋白、C-反应蛋白、钠尿肽等的应用大大提高了心肌梗死和心衰的诊断准确率;还能预估风险、提高治愈率,使心血管重大事件发生率大大下降。协助临床及时排除一些疑似患者,降低了治疗费用。这些新进展有里程碑意义,成为当前心血管疾病诊治的重要工具,也改变了许多心血管疾病的基本认识和诊断标准,提出了急性冠状动脉综合征的概念.重新定义了心肌梗死,大大推动了心脏病学的发展。
上述这些新标志物发现和临床应用已有十多年了,但是环顾国内,至今没有一本完整、详尽讨论这些新发现的专著。为了满足国内临床工作者、研究人员、检验学界同仁的需要,我们翻译了Alan Wu主编的《心脏标志物》第2版。《心脏标志物》是当今阐述上述这些新发现的权威著作,该书已成为有关心脏标志物的教科书。Dr.Alan Wu长期从事心脏标志物研究,是许多世界上有关心脏标志的应用指南和标准制定小组的首席科学家,闻名遐迩。
本书主要由山东大学齐鲁箧院心内科和检验科的同仁们翻译,部分章节特邀北京大学第一医院、北京大学第三医院和北京协和医学院阜外心血管病医院的教授翻译,他们精准的翻译为本书增色不少。
赵胜梅秘书做了大量的组织工作,在此一并感谢。

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