心脏标志物在终末期肾病中的预后价值：慢性血液透析与新型心脏标志物评估（CHANCE）研究

Prognostic value of cardiac markers in ESRD: Chronic Hemodialysis and New Cardiac Markers Evaluation (CHANCE) study.

作者信息

Iliou Marie C, Fumeron Christine, Benoit Marie O, Tuppin Philippe, Calonge Victorio Menoyo, Moatti Nicole, Buisson Claude, Jacquot Christian

机构信息

Groupe Hospitalier Broussais-Georges Pompidou, Paris, France.

出版信息

Am J Kidney Dis. 2003 Sep;42(3):513-23. doi: 10.1016/s0272-6386(03)00746-7.

DOI:10.1016/s0272-6386(03)00746-7

PMID:12955679

Abstract

BACKGROUND

Cardiac disease is the main cause of mortality in long-term hemodialysis patients. Cardiac troponins (cTn) have been proposed to be markers of cardiac damage, but their value is still debated in hemodialysis patients. The aim of this prospective study is to assess the prognostic value of biochemical cardiac markers in long-term hemodialysis patients.

METHODS

We measured serum levels of cTn I (cTnI), cTn T (cTnT), and creatine kinase-MB (CK-MB) in 258 asymptomatic patients (mean age, 60 +/- 15 years; 150 men) before the dialysis treatment. All causes of death and major adverse cardiac events (MACEs: cardiac death, myocardial infarction, or unstable angina) were recorded at 1 and 2 years of follow-up. A Cox proportional hazard regression model was used to identify factors predictive of mortality.

RESULTS

On inclusion, 48 patients (18.6%) had cTnT levels greater than 0.1 ng/mL, 46 patients (17.8%) had cTnI levels greater than 0.15 ng/mL, and 18 patients (7.0%) had CK-MB levels greater than 3 ng/mL. Of 246 patients followed up at 2 years, 64 patients (26%) had died, including 29 patients (11.8%) of cardiac disease, and 49 patients (19.9%) experienced at least 1 MACE. MACEs were significantly greater for patients with elevated predialysis serum cTnT and CK-MB levels (>0.1 ng/mL and 3 ng/mL, respectively) than for patients with normal levels of these cardiac markers (31.9% versus 17.1%; P = 0.01; 38.9% versus 18.4%; P = 0.02, respectively). No differences were found for cTnI levels. In multivariate analysis, age (relative risk [RR], 1.04; P = 0.002), previous ischemic heart disease (RR, 2.5; P = 0.0001), and serum cTnT levels greater than 0.1 ng/mL (RR, 1.9; P = 0.04) were independent significant factors for MACEs.

CONCLUSION

Increased predialysis serum levels of cTnT and CK-MB, but not cTnI, were predictive of a high risk for overall mortality and MACEs at 2 years in asymptomatic hemodialysis patients.

摘要

背景

心脏疾病是长期血液透析患者死亡的主要原因。心肌肌钙蛋白（cTn）已被提出作为心脏损伤的标志物，但其在血液透析患者中的价值仍存在争议。这项前瞻性研究的目的是评估生化心脏标志物在长期血液透析患者中的预后价值。

方法

我们在透析治疗前测量了258例无症状患者（平均年龄60±15岁；150例男性）的血清cTn I（cTnI）、cTn T（cTnT）和肌酸激酶同工酶（CK-MB）水平。在随访1年和2年时记录所有死亡原因和主要不良心脏事件（MACE：心源性死亡、心肌梗死或不稳定型心绞痛）。使用Cox比例风险回归模型来确定预测死亡率的因素。

结果

纳入研究时，48例患者（18.6%）的cTnT水平大于0.1 ng/mL，46例患者（17.8%）的cTnI水平大于0.15 ng/mL，18例患者（7.0%）的CK-MB水平大于3 ng/mL。在246例随访2年的患者中，64例患者（26%）死亡，其中29例患者（11.8%）死于心脏疾病，49例患者（19.9%）经历了至少1次MACE。透析前血清cTnT和CK-MB水平升高（分别>0.1 ng/mL和3 ng/mL）的患者发生MACEs的比例显著高于这些心脏标志物水平正常的患者（分别为31.9%对17.1%；P = 0.01；38.9%对18.4%；P = 0.02）。cTnI水平未发现差异。在多变量分析中，年龄（相对风险[RR]，1.04；P = 0.002）、既往缺血性心脏病（RR，2.5；P = 0.0001）和血清cTnT水平大于0.1 ng/mL（RR，1.9；P = 0.0