Löwbeer C, Ottosson-Seeberger A, Gustafsson S A, Norrman R, Hulting J, Gutierrez A
Department of Medical Laboratory Sciences and Technology, Huddinge University Hospital, Sweden.
Nephrol Dial Transplant. 1999 Aug;14(8):1948-55. doi: 10.1093/ndt/14.8.1948.
Cardiac troponin T (cTnT) is a highly sensitive marker for the detection of myocardial damage. However, patients maintained on chronic dialysis often have increased serum cTnT concentrations without evidence of acute myocardial injury. The reason for this is unclear. In chronic haemodialysis patients, elevated plasma concentrations of big endothelin-1 (big ET-1) and endothelin-1 (ET-1) have been reported which may be associated with ischaemic heart disease. The aim of the present study was to investigate possible associations between cTnT, big ET-1, ET-1, other cardiac markers and cardiac disease in dialysis patients.
Thirty-six haemodialysis (HD) patients and 26 peritoneal dialysis (PD) patients without symptoms of acute myocardial ischaemia were investigated. In all patients, serum concentrations of cTnT (2nd generation ELISA), cardiac troponin I (TnI) (Opus, Behring), creatine kinase MB (CKMB) mass and creatine kinase (CK) were determined, in HD patients before and after dialysis. Additionally, in HD patients, plasma ET-1 and big ET-1 were measured. In 27 HD patients, left ventricular mass index (LVMI) was determined. Patients with ischaemic heart disease (IHD) were compared with non-IHD patients.
Serum cTnT was elevated (> or =0.10 microg/l) in 20 of 36 HD patients and in eight of 26 PD patients. cTnI was elevated (> or =0.5 microg/l) in four of 62 dialysis patients. HD+PD patients with IHD showed higher cTnT than HD+PD patients without IHD, and ET-1 concentrations were higher in HD patients with than without IHD. In HD patients, there was a positive correlation between cTnT and big ET-1. In HD patients with left ventricular hypertrophy (LVH), serum cTnT, CKMB mass and post-dialysis plasma big ET-1 were higher than in patients with normal LVMI. Furthermore there was a positive correlation between cTnT levels and LVMI.
These findings suggest that circulating cTnT may reflect left ventricular hypertrophy and/or myocardial ischaemia in dialysis patients, and indicate that ET-1 and big ET-1 might be associated with these conditions.
心肌肌钙蛋白T（cTnT）是检测心肌损伤的高敏标志物。然而，维持性慢性透析患者的血清cTnT浓度常常升高，却无急性心肌损伤的证据。其原因尚不清楚。据报道，慢性血液透析患者血浆中大内皮素-1（big ET-1）和内皮素-1（ET-1）浓度升高，这可能与缺血性心脏病有关。本研究旨在探讨透析患者中cTnT、big ET-1、ET-1、其他心脏标志物与心脏疾病之间可能存在的关联。
对36例无急性心肌缺血症状的血液透析（HD）患者和26例腹膜透析（PD）患者进行研究。测定所有患者血清中cTnT（第二代酶联免疫吸附测定法）、心肌肌钙蛋白I（TnI）（奥普斯，贝林公司）、肌酸激酶同工酶MB（CKMB）质量浓度和肌酸激酶（CK），HD患者在透析前后进行测定。此外，测定HD患者血浆ET-1和big ET-1。对27例HD患者测定左心室质量指数（LVMI）。将缺血性心脏病（IHD）患者与非IHD患者进行比较。
36例HD患者中有20例、26例PD患者中有8例血清cTnT升高（≥0.10μg/L）。62例透析患者中有4例TnI升高（≥0.5μg/L）。IHD的HD+PD患者的cTnT高于无IHD的HD+PD患者，有IHD的HD患者的ET-1浓度高于无IHD的患者。在HD患者中，cTnT与big ET-1呈正相关。左心室肥厚（LVH）的HD患者血清cTnT、CKMB质量浓度和透析后血浆big ET-1高于LVMI正常的患者。此外，cTnT水平与LVMI呈正相关。
这些发现提示，循环中的cTnT可能反映透析患者的左心室肥厚和/或心肌缺血，表明ET-1和big ET-1可能与这些情况有关。
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