Mallamaci Francesca, Zoccali Carmine, Parlongo Saverio, Tripepi Giovanni, Benedetto Francesco A, Cutrupi Sebastiano, Bonanno Graziella, Fatuzzo Pasquale, Rapisarda Francesco, Seminara Giuseppe, Stancanelli Benedetta, Bellanuova Ignazio, Cataliotti Alessando, Malatino Lorenzo S
Divisione di Nefrologia e CNR, Centro di Fisiologia Clinica, Reggio Calabria, Italy.
Am J Kidney Dis. 2002 Jul;40(1):68-75. doi: 10.1053/ajkd.2002.33914.
Cardiac troponin T (cTnT) predicts death and cardiovascular outcomes in clinically stable patients with end-stage renal disease. Because this protein is synthesized exclusively in myocardial cells, its predictive power for these outcomes may be because it reflects, besides cardiac ischemia, left ventricular (LV) mass, which is a strong predictor of cardiovascular death in this population per se. We tested the relationship between cTnT level and LV mass and the predictive power of this cardiac protein for all-cause and cardiovascular mortality in a cohort of hemodialysis patients (n = 199) without acute coronary syndrome and heart failure followed up for an average of 35 months (range, 0.8 to 52 months). cTnT was measured by means of a third-generation electrochemiluminescence immunoassay. cTnT level was related directly to interventricular septum (r = 0.36; P < 0.001) and posterior wall thickness (r = 0.40; P < 0.001), as well as LV mass (r = 0.45; P < 0.001). On multivariate analysis, after age, LV mass was the strongest independent predictor of cTnT level (beta = 0.28; P < 0.001). Serum cTnT level was significantly related to all-cause and cardiovascular mortality on univariate analysis (P < 0.001). On multivariate Cox regression analysis, the adjusted risk for all-cause death was 2.39 times (95% confidence interval [CI], 1.13 to 5.06; P = 0.02) greater in patients in the third cTnT tertile than the first tertile, and a similar pattern emerged for cardiovascular mortality (hazard ratio, 2.35; 95% CI, 1.01 to 5.49; P = 0.048). In hemodialysis patients, plasma cTnT level is independently related to LV mass and predicts all-cause and cardiovascular mortality. These data support the hypothesis that this marker can be usefully applied for risk stratification in clinically stable dialysis patients.
心肌肌钙蛋白T（cTnT）可预测终末期肾病临床稳定患者的死亡及心血管事件结局。由于这种蛋白质仅在心肌细胞中合成，其对这些结局的预测能力可能是因为它除了反映心肌缺血外，还反映左心室（LV）质量，而左心室质量本身就是该人群心血管死亡的有力预测指标。我们在一组平均随访35个月（范围为0.8至52个月）的无急性冠脉综合征和心力衰竭的血液透析患者（n = 199）中，测试了cTnT水平与左心室质量之间的关系，以及这种心脏蛋白对全因死亡率和心血管死亡率的预测能力。cTnT采用第三代电化学发光免疫分析法进行检测。cTnT水平与室间隔厚度（r = 0.36；P < 0.001）、后壁厚度（r = 0.40；P < 0.001）以及左心室质量（r = 0.45；P < 0.001）直接相关。多因素分析显示，在调整年龄因素后，左心室质量是cTnT水平最强的独立预测因素（β = 0.28；P < 0.001）。单因素分析显示，血清cTnT水平与全因死亡率和心血管死亡率显著相关（P < 0.001）。多因素Cox回归分析表明，处于cTnT三分位数最高组的患者全因死亡的校正风险比处于最低组的患者高2.39倍（95%置信区间[CI]，1.13至5.06；P = 0.02），心血管死亡率也呈现类似模式（风险比，2.35；95% CI，1.01至5.49；P = 0.048）。在血液透析患者中，血浆cTnT水平与左心室质量独立相关，并可预测全因死亡率和心血管死亡率。这些数据支持以下假设：该标志物可有效应用于临床稳定的透析患者的风险分层。
