Lang K, Schindler S, Forberger C, Stein G, Figulla H R
Cardiology, Angiology, Intensive Care, Friedrich-Schiller-University, Jena, Germany.
Clin Nephrol. 2001 Jul;56(1):44-51.
Cardiovascular diseases determine overall mortality in patients with end-stage renal failure. Therefore, testing for myocardial ischemia is important. Elevation of cardio-specific troponins have been frequently measured in patients with end-stage renal failure. Thus, we studied systematically whether patients on chronic intermittent hemodialysis without overt coronary heart disease have increased serum levels of cardiac troponin T and cardiac troponin I. After 2 years, the patients were screened again for cardiac events.
The patients had no history of angina during the previous 3 months or myocardial infarction (MI) within the previous 2 years. For analysis we used two cardio-specific assays for troponin T as well as for troponin I and compared the results with the CK-MB concentration. In a number of patients serum concentrations were elevated above the reference range as follows: troponin T rapid bedside assay: 41 of 100 patients, troponin I rapid bedside assay: 27 of 100 patients, quantitative measurement oftroponin T: 22 of 100 patients, quantitative measurement oftroponin I: 7 of 100 patients, CK-MB: 2 of 100 patients. The increased serum levels of cardiac troponins were neither the result of uremic perimyocarditis (pericardial effusion), changes in the hemodialysis regimen, pulmonary congestion nor were they consistent with the etiology of renal failure. None of the patients with an elevated troponin level in either of the test suffered from any acute cardiac event initially. Within 2 years 18 of 100 patients died, 13 out of them because of cardiac events. Fourteen patients had a myocardial infarction and 19 patients developed angina pectoris. Sensitivity and specificity (0.75 and 0.67) of troponin T rapid bedside assay for MACE (angina pectoris, MI, cardiac death) was lower compared to studies in patients with normal renal function. Correlation between troponin elevation and late outcome was low or absent.
Patients on chronic intermittent hemodialysis frequently present with elevated TnT and TnI levels which cannot be used as predictors of acute and chronic cardiac events. Rapid bedside assays have a lower specificity than quantitative assays.
心血管疾病决定了终末期肾衰竭患者的总体死亡率。因此，检测心肌缺血很重要。终末期肾衰竭患者常检测心肌特异性肌钙蛋白水平。因此，我们系统研究了无明显冠心病的慢性间歇性血液透析患者血清心肌肌钙蛋白T和心肌肌钙蛋白I水平是否升高。2年后，再次对患者进行心脏事件筛查。
患者在过去3个月内无心绞痛病史，过去2年内无心肌梗死（MI）病史。分析时，我们使用了两种心肌特异性检测方法检测肌钙蛋白T和肌钙蛋白I，并将结果与肌酸激酶同工酶（CK-MB）浓度进行比较。部分患者血清浓度高于参考范围，情况如下：肌钙蛋白T快速床边检测：100例患者中有41例；肌钙蛋白I快速床边检测：100例患者中有27例；肌钙蛋白T定量检测：100例患者中有22例；肌钙蛋白I定量检测：100例患者中有7例；CK-MB：100例患者中有2例。血清心肌肌钙蛋白水平升高既不是尿毒症性心包心肌炎（心包积液）、血液透析方案改变、肺淤血所致，也与肾衰竭病因不符。两种检测中肌钙蛋白水平升高的患者最初均未发生任何急性心脏事件。100例患者中有18例在2年内死亡，其中13例死于心脏事件。14例患者发生心肌梗死，19例患者出现心绞痛。与肾功能正常患者的研究相比，肌钙蛋白T快速床边检测对主要不良心血管事件（MACE，心绞痛、心肌梗死、心源性死亡）的敏感性和特异性（分别为0.75和0.67）较低。肌钙蛋白升高与晚期预后之间的相关性较低或不存在。
慢性间歇性血液透析患者常出现肌钙蛋白T和肌钙蛋白I水平升高，这些水平不能用作急性和慢性心脏事件的预测指标。快速床边检测的特异性低于定量检测。
