中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (07): 497-501.doi: 10.3969/j.issn.1671-4091.2014.07.004

• 临床研究 • 上一篇    下一篇

维持性血液透析患者血清肌钙蛋白T水平的相关影响因素分析

徐雁1,富秀英2,孙美美1,傅立倩1,皮小陵1   

  1. 1. 上海市浦东新区公利医院肾内科
    2. 上海市黄浦区中心医院内科
  • 收稿日期:2014-02-20 修回日期:2014-03-20 出版日期:2014-07-12 发布日期:2014-07-12
  • 通讯作者: 皮小陵 pixiaoling1960@126.com E-mail:haoyishengxu@sina.com

The level of cardiac troponin T and its possible influence factors in maintenance hemodialysis patients

  • Received:2014-02-20 Revised:2014-03-20 Online:2014-07-12 Published:2014-07-12

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摘要： 目的 研究维持性血液透析（maintenance hemodialysis, MHD）患者血清心肌肌钙蛋白T（cardiac troponin T, cTnT）水平及其影响因素。方法 选取MHD治疗3个月以上的稳定患者，采用电化学发光法检测受试者血清cTnT。用Spearman相关和线性回归分析cTnT与其它指标之间的相关性。用受试者工作特征（receiver operating characteristic ,ROC）曲线比较cTnT、氨基末端脑钠肽原（amino-terminal pro-brain natriuretic peptide, NT-proBNP)及高敏C反应蛋白（high sensitive C-reactive protein , hsCRP）与心血管疾病（cardiovascular disease, CVD）和左心室肥大的相关性。结果 123例MHD患者血清cTnT中位数为0.046（0.028-0.066）ng/ml。合并CVD的患者血清cTnT水平显著高于非CVD患者（0.062[0.044-0.083]ng/ml vs 0.031[0.020-0.046]ng/ml，P=0.002）。糖尿病患者血清cTnT水平显著高于非糖尿病患者（0.061[0.042-0.102]ng/ml vs 0.044[0.025-0.064]ng/ml，P=0.003）。Spearman相关分析显示血清cTnT与年龄（ρ=0.309，P=0.001）、糖化白蛋白（ρ=0.192，P=0.040)、NT-proBNP（ρ=0.448，P<0.001）、hsCRP(ρ=0.335，P<0.001)、颈动脉内膜中层厚度(ρ=0.315，P=0.004)及左心室质量指数(ρ=0.369，P<0.001)呈正相关，与血清前白蛋白(ρ=-0.280，P=0.002)、高密度脂蛋白胆固醇（ρ=-0.201，P=0.047）呈负相关。线性回归分析显示年龄(β=0.204，P=0.043)、 NT-proBNP (β=0.299，P=0.010)及左心室质量指数(β=0.345，P=0.003)与血清cTnT水平独立相关。ROC曲线分析显示cTnT水平与CVD的相关性高于NT-proBNP 及hsCRP，与左心室肥大的相关性介于NT-proBNP与hsCRP之间。结论 MHD患者血清cTnT水平显著升高，cTnT水平升高与患者高龄、容量负荷、营养不良、微炎症状态、左心室肥大及伴发CVD相关。

关键词: 血液透析, 心肌肌钙蛋白T, 心血管疾病, 左心室肥大

Abstract: Objective To study the level of cardiac troponin T(cTnT) and its possible influence factors in maintenance hemodialysis(MHD) patients. Methods Blood was obtained from 123 MHD patients before undergoing hemodialysis, cTnT was measured by electro- chemoluminiscence immunoassay. Spearman correlation and linear regression were used to assess the relationship between cTnT and other parameters. Receiver operating characteristic (ROC) curves were used to assess the correlation with cTnT,amino-terminal pro-brain-natriuretic peptide (NT-proBNP), high-sensitive C reactive protein(hsCRP) and cardiovascular disease(CVD ) as well as left ventricular hypertrophy(LVH). Results The median value of serum cTnT was 0.046（0.028-0.066）ng/ml in 123 MHD patients, patients with cardiovascular disease(CVD) had higher cTnT levels than those without CVD(0.062[0.044-0.083]ng/ml vs 0.031[0.020-0.046]ng/ml, P=0.002), patients with diabetes mellitus(DM) had higher cTnT levels than those non-DM (0.061[0.042-0.102]ng/ml vs 0.044[0.025-0.064]ng/ml, P=0.003). In all MHD patients cTnT correlated positively with age(ρ=0.309, P=0.001), glycated albumin (ρ=0.192, P=0.040), NT-proBNP (ρ=0.448, P<0.001), hsCRP(ρ=0.335, P<0.001), carotid artery intima-media thickness (ρ=0.315, P=0.004) and left ventricular mass index(LVMI)(ρ=0.369, P<0.001); negatively with pre-albumin(ρ=-0.280, P=0.002), high density lipoprotein cholesterol(ρ=-0.201, P=0.047). Linear regression analysis showed age (β=0.204, P=0.043), NT-proBNP (β=0.299, P=0.010) and LVMI (β=0.345, P=0.003) were independently associated cTnT. ROC curves analysis showed the correlation between cTnT and CVD was more closely than NT-proBNP and hsCRP, the correlation between cTnT and LVH was lower than NT-proBNP,and higher than hsCRP. Conclusions Serum cTnT is markedly elevated in MHD patients; Serum cTnT is associated with advanced age, fluid overload, malnutrition, microinflammation, LVH and CVD in MHD patients.

Key words: hemodialysis, cardiac troponin T, cardiovascular disease, left ventricular hypertrophy