Abbas Nasir A, John R Ian, Webb Michelle C, Kempson Michelle E, Potter Aisling N, Price Christopher P, Vickery Susan, Lamb Edmund J
Department of Renal Medicine, East Kent Hospitals NHS Trust, Canterbury, UK.
Clin Chem. 2005 Nov;51(11):2059-66. doi: 10.1373/clinchem.2005.055665. Epub 2005 Sep 15.
Serum cardiac troponin concentrations are commonly increased in end-stage renal disease (ESRD) in the absence of an acute coronary syndrome (ACS). The data on cardiac troponin I (cTnI) are more variable than those for cardiac troponin T (cTnT). There is little information on cardiac troponin concentrations in patients with chronic kidney disease (CKD) who have not commenced dialysis.
We studied 222 patients: 56 had stage 3 (moderate CKD); 70 stage 4 (severe CKD); and 96 stage 5 (kidney failure). Patients underwent echocardiography and were followed prospectively for a median of 19 months; all-cause mortality was recorded.
Overall, serum cTnT was increased above the 99th percentile reference limit in 43% of all CKD patients studied, compared with 18% for cTnI. Serum cTnT and cTnI concentrations were more commonly increased in the presence of more severe CKD (11 and 6 patients in stage 3, 27 and 8 in stage 4, and 57 and 24 in stage 5 (P < 0.0001 and <0.02, respectively). Among 38 patients with detectable cTnI, 32 had detectable cTnT (r(s) = 0.67; P < 0.0001). There was evidence that decreasing estimated glomerular filtration rate increased the odds of having detectable cTnT (P < 0.001) but not cTnI (P = 0.128). There was no evidence to support an adjusted association of detectable cardiac troponins with increasing left ventricular mass index. Increased cTnT (P = 0.0097), but not cTnI, was associated with decreased survival.
Increased cTnT and cTnI concentrations are relatively common in predialysis CKD patients, in the absence of an ACS, including among those with stage 3 disease. The presence of left ventricular hypertrophy alone does not explain these data. Detectable cTnT was a marker of decreased survival.
在终末期肾病（ESRD）患者中，血清心肌肌钙蛋白浓度通常会升高，且不存在急性冠状动脉综合征（ACS）。心肌肌钙蛋白I（cTnI）的数据比心肌肌钙蛋白T（cTnT）的数据更具变异性。对于尚未开始透析的慢性肾脏病（CKD）患者，关于心肌肌钙蛋白浓度的信息很少。
我们研究了222例患者：56例为3期（中度CKD）；70例为4期（重度CKD）；96例为5期（肾衰竭）。患者接受了超声心动图检查，并进行了为期19个月的前瞻性随访；记录全因死亡率。
总体而言，在所有研究的CKD患者中，43%的患者血清cTnT升高至第99百分位数参考限值以上，而cTnI为18%。在更严重的CKD患者中，血清cTnT和cTnI浓度更常升高（3期分别为11例和6例，4期为27例和8例，5期为57例和24例（P分别<0.0001和<0.02）。在38例可检测到cTnI的患者中，32例可检测到cTnT（r(s)=0.67；P<0.0001）。有证据表明，估计肾小球滤过率降低会增加可检测到cTnT的几率（P<0.001），但不会增加cTnI的几率（P=0.128）。没有证据支持可检测到的心肌肌钙蛋白与左心室质量指数增加之间存在校正关联。cTnT升高（P=0.0097），而非cTnI，与生存率降低相关。
在无ACS的情况下，包括3期疾病患者在内，透析前CKD患者中cTnT和cTnI浓度升高相对常见。仅左心室肥厚的存在并不能解释这些数据。可检测到的cTnT是生存率降低的一个标志物。
