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    3. ??

    5. ??????????

    6. ??????(MI)????????? ???????????3-4??,Troponins?CKMB???????,???????????? ?????????,Troponins???????,????????????,????AMI????????? ??Troponins??????????????,????????7-14?,????????AMI??????????????????3-4??,Troponins?CKMB???????,???????????? ?????????,Troponins???????,????????????,????AMI????????? ??Troponins??????????????,????????7-14?,????????AMI???????

    7. ???????AMI?????????????? ??20??50??,AST(???????? )?????????????????AMI???,??1958??WHO??AMI?????? ?60-80??,???????????,CK?CKMB?myoglobin?????????????,WHO?????????????? Troponins??????????,????????,????????????????AMI?????????????? ??20??50??,AST(???????? )?????????????????AMI???,??1958??WHO??AMI?????? ?60-80??,???????????,CK?CKMB?myoglobin?????????????,WHO?????????????? Troponins??????????,????????,?????????

    8. ????????? 1979?: WHO?????(MI)????:???? 3???2?: ???? (??:??) ???????(GOT, LDH,CK, CK-MB) ???????? (??ST???) ???????????????,???????????? 2000?: ESC/ACC (???????/???????)??????????:??????????????? (????)????????? (CK-MB),????????: ???? (??:??) ???ECG?? (ST?, Q?) ?????????????,?????????CK-MB

    9. ????????? 2007?: ESC/ACCF/AHA/WHF??????????????:??????????(???????)???/???,??1???????99??????,????????: ???? ECG?? ????? ?????????,????????,?99??????????

    10. ????????????

    11. ????????????????????? The cardiac Troponin I and cardiac Troponin T isoforms have demonstrated a very high cardiac specificity and sensitivityThe cardiac Troponin I and cardiac Troponin T isoforms have demonstrated a very high cardiac specificity and sensitivity

    12. 2007 ESC ACS Guideline?Troponins???????????? Troponins???????CKMB??????????? Myoglobin????????????????,????????? Troponins???AMI????????????????? Troponins??????????CKMB???NSTE-ACS???????? ????6-12??Troponins?????????AMI 2007?Troponins??ESC????????????2007?Troponins??ESC????????????

    13. ACS ?????Troponins???(2007 ESC ACS Guideline) 2007?ESC???,Troponins????????ACS???????????? Troponins??,???ST/T????????ST???????????ST????? ????6-12??Troponins??????????AMI,???????????? 2007?ESC???,Troponins????????ACS???????????? Troponins??,???ST/T????????ST???????????ST????? ????6-12??Troponins??????????AMI,????????????

    14. ??

    15. ??????????? ????T?????I?????? ????I??????? ??????T????? ??????????????WHO?????

    16. ??????????? ????T?????I?????? ????I??????? ??????T????? ??????????????WHO?????

    17. Troponin T?Troponin I???????????,???????? Troponin T?Troponin I???????????,????????

    18. Troponin T???????? Troponin I???????,?????????????Troponin T???????? Troponin I???????,?????????????

    19. ??????????? ????T?????I?????? ????I??????? ??????T????? ??????????????WHO?????

    20. cTnI???????

    21. ??TnI ????????????????

    24. ??????????I???????? ???cTnI??????????????????20?????? ???????????????????????,?????????????????????????????? ??????????????????????????,?????????????? ??cTnI ??????, ?????????????????????????????Tn?????????????????

    25. ??????????? ????T?????I?????? ????I??????? ??????T????? ??????????????WHO?????

    28. ????????ACS????ACS???? 22.7% ?????AMI??130???(7.2%) ?ST???

    30. ????????:??????T???????????

    31. ????????:??????T,???????????

    32. ??????????? ????T?????I?????? ????I??????? ??????T????? ??????????????WHO?????

    33. ????????????????

    34. ?????????????????,?????????????????(????) ?????????CK-MB,????????????????????99???? ?????99??????????? = ?????10% NACB?IFCC????ACS??????????

    36. ??

    37. ??????T????????? ??????T?????? ??????T?ACS????????

    38. ??????T????????? ??????T?????? ??????T?ACS????????

    40. Elecsys® TnT-hs ?????????T?????

    44. ??????T????????? ??????T?????? ??????T?ACS????????

    45. ????????????T????????????:APACE?? ?????????: ?????????????????,??????????: Advantageous Predictors of Acute Coronary Syndrome Evaluation (APACE) ???????????????? 5 ???: 3 ????, 1 ????, 1 ????? ??: n = 786 ????: ????? (ED) ?AMI (??????)???,???????????12??? ????: ?????????????

    47. ?????? (cTn) ??: ?????? ????,??????1, 2, 3?6?? ???????(ROC)???????cTns ?? ?????cTn??, ?????????????????: Abbott cTnI-Architect Siemens cTnI-Ultra Roche cTnT-hs Roche cTnI Roche cTnT gen 4th

    48. ????????????,??????T?????????ESC?ACC?????????? 5???????????Roche TnT-hs?Siemens TnI-Ultra??ESC?ACC?????,:?10%?CV?=?99???? *1: ??TnT-hs LoD = 0.003 µg/L (?????) *2: ??Roche TnI LoD = 0.16 µg/L (?????)

    49. APACE ?? -???? 17% ?????AMI (123/718) ,16%???????????

    51. ??????T?????????????TAPACE ????:

    52. ??????T?????????????TAPACE ????:

    53. ROC??????cTn???????, ???TnT?? < 0.01 ng/ml (LoD)???????????????????????????????; TnT-hs????0.003 ng/mL (LoD)????? ?????(0.003 - 0.010 ng/mL)?????TnT????,???????????? ??ROC????????????????????????

    54. ?????,??????T?????????????T APACE ????:

    56. ???????,??????T?????????????APACE ????

    57. ???????,??????T?????????????APACE ???? ?????cTn?1??&2?????????????????AUC,???1???2?????AUC????

    58. ?????????,??????T???????APACE???? ?AMI??,??cTn????????????????? ??Tn????????????????????????????????????cTn????????

    59. ????????(AMI)????????T????????????T APACE ????: 4?????cTn?????“??”?“??”AMI?????: 4?????cTn????????????????????AUC???0.94?0.96,????????????cTn?? ???????????????????Tn????????,??????????cTn???????“??”????? ????cTn?????????????“??”AMI??99????URL????????Abbott ? Roche TnI?97%; ??Siemens TnI ultra?98%,??Roche TnT-hs?99%

    60. ?????????(UA)????????T??????????????APACE ???? ?Tn????UA???????????????,?????????? ??????????????????Roche cTnT-hs ?????????????AMI???,????UA??????????????

    61. APACE ???? ?cTn?????AMI??????????????????????????,?????????????? ????cTn?????????AMI?,????“??”?“??”AMI???: ????“??”?????????,????????????????????????? ??????ECG????,?cTn????????????????????????,??????????,??????????

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