Ooi D S, Zimmerman D, Graham J, Wells G A
Division of Biochemistry, Ottawa Hospital-Civic Campus, 1053 Carling Ave., Ottawa, ON K1Y 4E9 Canada.
Clin Chem. 2001 Mar;47(3):412-7.
Increased plasma troponin T (cTnT), but not troponin I (cTnI), is frequently observed in end-stage renal failure patients. Although generally considered spurious, we previously reported an associated increased mortality at 12 months.
We studied long-term outcomes in 244 patients on chronic hemodialysis for up to 34 months, correlating the outcomes to plasma cTnT in routine predialysis samples. In addition, subsequent plasma samples at least 1 year later and within 6 months of data analysis were available in 97 patients and were used to identify patients with increasing plasma cTnT. The endpoints used were death and new or worsening coronary, cerebro-, and peripheral vascular disease and neuropathy.
Transplantation occurred more frequently in patients with low initial cTnT: 31%, 13%, and 3% in the groups with cTnT < 0.010, 0.010-0.099, and > or = 0.100 microg/L, respectively. In the same groups, total deaths occurred in 6%, 43%, and 59% and cardiac deaths in 0%, 14%, and 24% of patients. In patients with follow-up samples, the group with increasing cTnT had a significantly increased death (relative risk, 2.0; P = 0.028). The increase was mainly in cardiac and sudden deaths.
Higher plasma cTnT predicts long-term all-cause mortality in hemodialysis patients, even at concentrations < 0.100 microg/L, as does an increasing cTnT concentration over time.
在终末期肾衰竭患者中，常观察到血浆肌钙蛋白T（cTnT）升高，但肌钙蛋白I（cTnI）未升高。尽管通常认为这是假性升高，但我们之前报告称其与12个月时死亡率增加相关。
我们研究了244例接受慢性血液透析长达34个月的患者的长期预后，并将预后与常规透析前样本中的血浆cTnT相关联。此外，97例患者可获得至少1年后及数据分析后6个月内的后续血浆样本，用于确定血浆cTnT升高的患者。所使用的终点指标为死亡以及新发或加重的冠状动脉、脑血管和外周血管疾病及神经病变。
初始cTnT水平低的患者移植发生率更高：cTnT<0.010、0.010 - 0.099及≥0.100μg/L组的移植发生率分别为31%、13%和3%。在相同组中，患者的总死亡率分别为6%、43%和59%，心脏性死亡分别为0%、14%和24%。在有随访样本的患者中，cTnT升高组的死亡风险显著增加（相对风险，2.0；P = 0.028）。增加主要为心脏性死亡和猝死。
较高的血浆cTnT可预测血液透析患者的长期全因死亡率，即使浓度<0.100μg/L时也是如此，cTnT浓度随时间增加同样如此。
