冠狀動脈疾病（coronary artery disease, CAD）是發達國家死亡和殘疾的主要原因， 佔 35 歲以上人口死亡總數的三分之一以上。其中，急性冠心症（acute coronary syndrome, ACS）是指由于冠狀動脈血流突然減少而與急性心肌缺血和/或心肌梗塞相通的一系列病 症。如果心電圖量測沒有變化，則通常被列為“可能的 ACS”。 臨床上必須迅速評估這 類被懷疑 ACS 的患者，以區分哪些人具有危及生命的緊急情況，哪些人只是具有良性 的原因。 臨床上作為心臟疾病的診斷機制有分為兩大系統，分別為以心電圖機量測生理電訊 號，經由訊號處理後，以心電圖之波型及其特徵進行診斷；另一系統為利用血液中之 生化信號，以專一性的生物標誌物進行標記，信號強度進行診斷。目前 12 導程心電圖 是最常見的檢查，通常應在患者到達急診室的 10 分鐘內進行並區分患者胸部不適的症 狀，以評估是否有心臟缺血或損傷。但是，心電圖可能相對正常或最初無法診斷。但 是，即使是正常的心電圖也不能排除 ACS(此種情況發生率為 1％〜6％)，故亦常使用 心臟內心肌酶的存在或濃度上升與否來做為評估心臟缺血的指標之一，可與心電圖相 輔相成，做為共同診斷的工具。 論文中設計出一套生化檢測系統，用於檢測血液中之心血管生物標記物。與一般醫 院生物標記物之檢測系統不同，以自組裝單層膜(self-assembled monolayers, SAMs)對抗 生物分子的非特異性吸附，大幅增加檢測系統之專一性，此外，微型的檢測系統也能達 到即時檢驗(Point of care testing , POCT )的即刻檢測及快速診斷的兩大助益。作為佐證， 能同時與心電圖系統一同應用於冠狀動脈疾病前期之預判，在電生理與電化學等兩項目 前醫療系統賴於診斷的系統，做出提前預防、早期診斷等相關性的連結。 因此，本研究目標為：採用新型心血管標記物快速檢測系統，迅速評斷患者 是否需要接受更多侵入性檢查或更昂貴的干預治療，讓那些不需要進行進一步檢查的 病人減少醫療支出，釋放社會中不必要之醫療資源占用，降低醫療成本及人力的過度 使用，使醫院得以救治更多的病人。;Coronary artery disease (CAD) represents a major cause of death and disability in developed countries and accounts for more than one-third of all deaths in individuals over the age 35. Among them, acute coronary syndrome (ACS) has evolved as a useful operational term that refers to a spectrum of conditions compatible with acute myocardial ischemia and/or infarction due to an abrupt reduction in coronary blood flow. The term “possible ACS” is often assigned during initial evaluation if the ECG is unrevealing is not yet available. Patients with suspected ACS must be evaluated rapidly to identify those with a life-threatening emergency versus those with a more benign condition.
Clinically, there are two types of systems for ACS diagnosis. Measuring the Physiological signal with ECG system. The syndrome will be diagnosed by waves and characteristic of ECG. Another system detect the biochemistry signal in blood which come from heart. The biomarkers also have high specificity in heart.
A 12-lead ECG is the commonest examination, which routinely should be performed and interpreted within 10 minutes of the patient’s presentation to ED with the symptom of chest discomfort, to assess for cardiac ischemia or injury. However, the ECG can be relatively normal or initially nondiagnostic. Furthermore, even a normal ECG does not exclude ACS and occurs in 1% to 6% of such patients.
In order to detect the biomarkers in blood which come from heart, we design a new detection system in thesis. Different from clinical detection system, we use the self-assembled monolayers(SAMs) to avoid non-specific binding of biomolecules. This method increase specificity of detection system drastically. In addition, this rapid detection system also achieve the two benefits of immediate detection and rapid diagnosis of point of care testing (POCT).
Therefore, the goal of this study is to use a rapid detection system for new cardiovascular biomarkers to quickly determine whether patients need more invasive tests or more expensive interventions. The patients who do not need further examinations will reduce their medical expenditures. The unnecessary use of medical resources in society reduces the cost of medical care and the excessive use of manpower, enabling hospitals to treat more patients.
