Sharma Rajan, Gaze David C, Pellerin Denis, Mehta Rajnikant L, Gregson Helen, Streather Christopher P, Collinson Paul O, Brecker Stephen J D
Department of Cardiology, St George's Hospital, London, UK.
Am J Kidney Dis. 2006 Mar;47(3):493-502. doi: 10.1053/j.ajkd.2005.11.026.
The primary study aim is to determine whether ischemia-modified albumin (IMA) levels predict mortality in patients with end-stage renal disease (ESRD). The secondary aim is to determine characteristics of patients with elevated IMA levels.
A prospective observational study of 114 renal transplantation candidates was performed. All underwent coronary angiography and dobutamine stress echocardiography. The primary end point is total mortality.
During a follow-up period of 2.25 +/- 0.71 years, there were 18 deaths; 10 were cardiac related. Diabetes, severe coronary artery disease, positive dobutamine stress echocardiography result, cardiac troponin T (cTnT) level, IMA level, left ventricular (LV) end-systolic diameter, LV ejection fraction, left atrial size, and mitral peak velocity of early filling (E)/early diastolic velocity (Ea) ratio all predicted mortality. The receiver operating characteristic area under the curve for mortality prediction was similar for IMA and cTnT levels. An IMA level of 95 KU/L or greater (n = 46) predicted mortality with a sensitivity of 76% and specificity of 74%. cTnT level of 0.06 ng/mL or greater (> or = 0.06 microg/L; n = 51) predicted mortality with a sensitivity of 75% and specificity of 72%. Thirty-eight patients (33%) had both IMA and cTnT levels elevated. With multivariate analysis, a positive dobutamine stress echocardiography result (P = 0.003), combined elevated IMA and cTnT levels (P = 0.005), and E/Ea ratio (P = 0.009) were independent prognostic factors. IMA and cTnT levels alone were not independent predictors of mortality. Patients with an elevated IMA level had a significantly larger LV size, decreased LV systolic function, and greater E/Ea ratio compared with those without an increased level.
IMA level predicts mortality in patients with ESRD. Patients with elevated levels have larger LV size, decreased systolic function, and greater estimated LV filling pressures.
主要研究目的是确定缺血修饰白蛋白（IMA）水平是否可预测终末期肾病（ESRD）患者的死亡率。次要目的是确定IMA水平升高患者的特征。
对114例肾移植候选者进行了一项前瞻性观察研究。所有患者均接受了冠状动脉造影和多巴酚丁胺负荷超声心动图检查。主要终点是全因死亡率。
在2.25±0.71年的随访期内，有18例死亡；10例与心脏相关。糖尿病、严重冠状动脉疾病、多巴酚丁胺负荷超声心动图检查结果阳性、心肌肌钙蛋白T（cTnT）水平、IMA水平、左心室（LV）收缩末期内径、LV射血分数、左心房大小以及二尖瓣早期充盈峰值速度（E）/舒张早期速度（Ea）比值均能预测死亡率。IMA和cTnT水平预测死亡率的受试者工作特征曲线下面积相似。IMA水平≥95 KU/L（n = 46）预测死亡率的敏感性为76%，特异性为74%。cTnT水平≥0.06 ng/mL（≥0.06 μg/L；n = 51）预测死亡率的敏感性为75%，特异性为72%。38例患者（33%）的IMA和cTnT水平均升高。多因素分析显示，多巴酚丁胺负荷超声心动图检查结果阳性（P = 0.003）、IMA和cTnT水平联合升高（P = 0.005）以及E/Ea比值（P = 0.009）是独立的预后因素。单独的IMA和cTnT水平不是死亡率的独立预测因素。与IMA水平未升高的患者相比，IMA水平升高的患者LV尺寸明显更大，LV收缩功能降低，E/Ea比值更高。
IMA水平可预测ESRD患者的死亡率。IMA水平升高的患者LV尺寸更大，收缩功能降低，并具有更高的LV充盈压估计值。
