Löwbeer C, Stenvinkel P, Pecoits-Filho R, Heimbürger O, Lindholm B, Gustafsson S A, Seeberger A
Division of Clinical Chemistry, Department of Medical Laboratory Sciences and Technology, Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden.
J Intern Med. 2003 Feb;253(2):153-60. doi: 10.1046/j.1365-2796.2003.01069.x.
Cardiac troponin T (cTnT) is a highly sensitive and specific marker of myocardial damage. It has been shown that elevated serum concentrations of cTnT in haemodialysis (HD) patients are associated with poor prognostic outcome. The aim of the present study was to investigate the predictive value of cTnT in samples from predialysis patients and to investigate associations between cTnT and inflammatory markers, such as C-reactive protein (CRP) and interleukin-6 (IL-6).
Cohort, follow-up study.
Huddinge University Hospital, Sweden.
A total of 115 (62% males, 28% diabetic patients) end-stage renal disease (ESRD) patients (52 +/- 1 years), of which 29% had cardiovascular disease (CVD), were studied shortly before the onset of dialysis therapy. Sixty-four patients started peritoneal dialysis (PD) as renal replacement therapy, whilst 49 started HD during the follow-up.
The cTnT was analysed with the third generation TnT assay on Elecsys 2010. The prognostic value was calculated for cTnT, IL-6, age, CVD, malnutrition, diabetes mellitus (DM) and gender. Survival analyses were made with Kaplan-Meier and Cox regression analyses, with all-cause mortality as the clinical end point (mean follow-up period 2.7 +/- 0.1 years).
Significant correlations were found between cTnT and CKMB (rho = 0.52, P < 0.0001), IL-6 (rho = 0.23, P < 0.05), CRP (rho = 0.30, P < 0.05), and serum albumin (rho = -0.31, P < 0.001), respectively. Diabetic patients had higher median serum cTnT level (0.09 microg L-1; range <0.01-0.51 vs. 0.04 microg L-1; range <0.01-0.67 microg L-1; P < 0.005) compared with nondiabetic patients. Likewise, patients with CVD had a significantly higher median level (0.08 microg L-1; range <0.01-0.67 microg L-1 vs. 0.04 microg L-1; range <0.01-0.61 microg L-1; P < 0.01) of cTnT compared with patients without CVD. Patients with cTnT > or =0.10 microg L-1 had a higher cumulative mortality rate than patients with cTnT < 0.10 microg L-1 (chi2 = 7.04; P < 0.01). Whilst age, CVD, malnutrition, DM, IL-6, cTnT and male gender were associated with poor outcome in the univariate analysis, only DM (P < 0.05) and cTnT (P < 0.05) were independently associated with mortality in a multivariate analysis.
The present study demonstrates that serum concentrations of cTnT > or =0.10 microg L-1 is a significant predictor of mortality in patients starting dialysis. Moreover, the positive correlations between cTnT and IL-6, and CRP, respectively, suggest an association between inflammation and cTnT levels. Finally, the results of the present study suggest that cTnT is an independent predictor of mortality in ESRD patients starting dialysis.
心肌肌钙蛋白T(cTnT)是心肌损伤的一种高度敏感且特异的标志物。研究表明,血液透析(HD)患者血清cTnT浓度升高与不良预后相关。本研究的目的是探讨cTnT在透析前患者样本中的预测价值,并研究cTnT与炎症标志物如C反应蛋白(CRP)和白细胞介素-6(IL-6)之间的关联。
队列随访研究。
瑞典胡丁厄大学医院。
共115例(62%为男性,28%为糖尿病患者)终末期肾病(ESRD)患者(52±1岁),其中29%患有心血管疾病(CVD),在透析治疗开始前不久进行研究。64例患者开始接受腹膜透析(PD)作为肾脏替代治疗,49例在随访期间开始接受HD治疗。
使用Elecsys 2010上的第三代TnT检测法分析cTnT。计算cTnT、IL-6、年龄、CVD、营养不良、糖尿病(DM)和性别的预后价值。采用Kaplan-Meier法和Cox回归分析进行生存分析,以全因死亡率作为临床终点(平均随访期2.7±0.1年)。
分别发现cTnT与肌酸激酶同工酶(CKMB)(rho = 0.52,P < 0.0001)、IL-6(rho = 0.23,P < 0.05)、CRP(rho = 0.30,P < 0.05)和血清白蛋白(rho = -0.31,P < 0.001)之间存在显著相关性。与非糖尿病患者相比,糖尿病患者的血清cTnT中位数水平更高(0.09μg/L;范围<0.01 - 0.51 vs. 0.04μg/L;范围<0.01 - 0.67μg/L;P < 0.005)。同样,与无CVD的患者相比,患有CVD的患者cTnT中位数水平显著更高(0.08μg/L;范围<0.01 - 0.67μg/L vs. 0.04μg/L;范围<0.01 - 0.61μg/L;P < 0.01)。cTnT≥0.10μg/L的患者累积死亡率高于cTnT<0.10μg/L的患者(χ2 = 7.04;P < 0.01)。在单因素分析中,年龄、CVD、营养不良、DM、IL-6、cTnT和男性性别与不良预后相关,但在多因素分析中,只有DM(P < 0.05)和cTnT(P < 0.05)与死亡率独立相关。
本研究表明,血清cTnT浓度≥0.10μg/L是开始透析患者死亡率的重要预测指标。此外,cTnT与IL-6和CRP之间的正相关分别提示炎症与cTnT水平之间存在关联。最后,本研究结果表明cTnT是开始透析的ESRD患者死亡率的独立预测指标。