Apple Fred S, Murakami MaryAnn M, Pearce Lesly A, Herzog Charles A
Department of Laboratory Medicine and Pathology , Hennepin County Medical Center, University of Minnesota School of Medicine, Minneapolis, Minn 55415, USA.
Circulation. 2002 Dec 3;106(23):2941-5. doi: 10.1161/01.cir.0000041254.30637.34.
This study determined the prevalence of increased cardiac troponin I (cTnI) and T (cTnT) in end-stage renal disease (ESRD) patients and whether an increased troponin was predictive of death.
Serum was obtained from 733 ESRD patients and measured for cTnI and cTnT. Relative risks were estimated using Cox proportional hazards regressions univariately and adjusted for age, time on dialysis, and coronary artery disease. Kaplan-Meier curves compared time to event data between groups. Greater percentages of patients had an increased cTnT versus cTnI at each cutoff, as follows: 99th percentile, 82% versus 6%; 10% coefficient of variation, 53% versus 1.0%; and receiver operator characteristic, 20% versus 0.4%. Increased versus normal cTnT was predictive of increased mortality using all cutoffs and only above the 99th percentile for cTnI. Two-year cumulative mortality rates increased (P<0.001) with changes in cTnT from normal (<0.01 microg/L, 8.4%) to small (> or =0.01 to <0.04 microg/L, 26%), moderate (> or =0.04 to <0.1 microg/L, 39%), and large (> or =0.1 microg/L, 47%) increases. Two-year mortalities were 30% for cTnI <0.1 microg/L and 52% if > or =0.1 microg/L. Univariate and adjusted relative risks of death associated with elevated (>99th percentile) cTnT were 5.0 (CI, 2.5 to 10; P<0.001) and 3.9 (CI, 1.9 to7.9; P<0.001) and cTnI were 2.0 (CI, 1.3 to 3.3; P=0.008) and 2.1 (CI, 1.3 to 3.3; P=0.007). Age, coronary artery disease, and time on dialysis were also independent predictors of mortality.
Increases in cTnT and cTnI in ESRD patients show a 2- to 5-fold increase in mortality, with a greater number of patients having an increased cTnT.
本研究确定了终末期肾病（ESRD）患者中心脏肌钙蛋白I（cTnI）和肌钙蛋白T（cTnT）升高的患病率，以及肌钙蛋白升高是否可预测死亡。
从733例ESRD患者中获取血清，检测cTnI和cTnT。使用Cox比例风险回归单因素估计相对风险，并对年龄、透析时间和冠状动脉疾病进行校正。Kaplan-Meier曲线比较了各组之间的事件发生时间数据。在每个临界值处，cTnT升高的患者百分比高于cTnI，如下：第99百分位数，82%对6%；变异系数10%，53%对1.0%；以及受试者工作特征曲线，20%对0.4%。使用所有临界值且仅在cTnI高于第99百分位数时，cTnT升高与正常相比可预测死亡率增加。随着cTnT从正常（<0.01μg/L，8.4%）增加到轻度（≥0.01至<0.04μg/L，26%）、中度（≥0.04至<0.1μg/L，39%）和重度（≥0.1μg/L，47%）升高，两年累积死亡率增加（P<0.001）。cTnI<～0.1μg/L时两年死亡率为30%，≥0.1μg/L时为52%。与cTnT升高（>第99百分位数）相关死亡的单因素和校正后相对风险分别为5.0（CI，2.5至10；P<0.001）和3.9（CI，1.9至7.9；P<0.001），cTnI分别为2.0（CI，1.3至3.3；P=0.008）和2.l（CI，1.3至3.3；P=0.007）。年龄、冠状动脉疾病和透析时间也是死亡率的独立预测因素。
ESRD患者中cTnT和cTnI升高显示死亡率增加2至5倍，且cTnT升高的患者更多。
