Troponine dosée avec un test de haute sensibilité : éléments de réponse aux questions fréquemment posées

Annales françaises de médecine d'urgence - Tập 4 - Trang 221-241 - 2014
C. Chenevier-Gobeaux1, E. Bonnefoy-Cudraz2, S. Charpentier3, M. Dehoux4, G. Lefevre5, C. Meune6, P. Ray7
1Service de diagnostic biologique automatisé, GH Cochin-Broca-Hôtel-Dieu, HUPC, Assistance publique-Hôpitaux de Paris (AP-HP), Paris cedex 14, France
2Service de cardiologie, hôpital Louis-Pradel, hospices civils de Lyon, équipe évaluation et modélisation des thérapeutiques, UMR CNRS 5558, université Lyon 1, Lyon, France
3Service d’accueil des urgences, hôpital Rangueil, CHU de Toulouse, université Paul-Sabatier, Toulouse-III, Toulouse, France
4Laboratoire de biochimie, hôpital Bichat-Claude-Bernard, HUPNVS, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
5Laboratoire de biochimie et d’hormonologie, hôpital Tenon, HUEP, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
6Service de cardiologie, hôpital Avicenne, HUPSSD, Assistance publique-Hôpitaux de Paris (AP-HP), Bobigny, université Paris-XIII, Paris, France
7Service d’accueil des urgences, hôpital Tenon, HUEP, Assistance publique-Hôpitaux de Paris (AP-HP), université Pierre-et-Marie-Curie, Paris-VI, Paris, France

Tóm tắt

L’évolution rapide des méthodes de dosage des troponines cardiaques (cTn) vers une meilleure sensibilité analytique (cTn de haute sensibilité ou cTn HS) s’accompagne de nombreuses données de la littérature, mais encore incomplètes. En l’absence de standardisation des cTn et de données consensuelles sur l’utilisation et l’interprétation des résultats, les auteurs de cette revue proposent, à partir d’une revue de la littérature, et de façon multidisciplinaire, des éléments de réponses aux questions fréquemment posées. En conclusion, le bon usage des cTn HS repose sur la connaissance : 1) des caractéristiques propres de la méthode utilisée, en particulier de la précision obtenue au 99e percentile d’une population de référence ; 2) des facteurs de variation de la valeur du 99e percentile ; 3) de la forte individualité des dosages de cTn HS, pour lesquels la notion de cinétique individuelle est plus informative que la simple référence à des valeurs usuelles. La significativité des variations entre deux dosages n’est pas encore documentée pour toutes les méthodes HS. La collaboration entre cliniciens et biologistes est nécessaire à une meilleure utilisation des troponines au quotidien.

Tài liệu tham khảo

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