Brunet Philippe, Oddoze Christiane, Paganelli Franck, Indreies Monica, Faure Valérie, Opris-Saveanu Adriana, Morange Sophie, Portugal Henri, Dussol Bertrand, Berland Yvon
Centre de Néphrologie et de Transplantation Rénale, Hôpital de la Conception, Aix-Marseille Université et Assistance-Publique Hôpitaux de Marseille, Marseille, France.
Int J Cardiol. 2008 Sep 26;129(2):205-9. doi: 10.1016/j.ijcard.2007.07.004. Epub 2007 Jul 27.
There is a reluctance to use cardiac troponins (cTn) for the monitoring of acute coronary syndrome (ACS) in hemodialysis (HD) patients because renal failure per se is thought to lead to increased cTn levels. The aim of this study was to analyse the proportion of patients with increased cTn levels in HD patients without ACS.
cTnI was measured with the AccuTnI(trade mark) from Beckman (cTnI-B) and Troponin I Stat(trade mark) from Dade Behring (cTnI-DB) assays; cTnT was measured with the third generation assay from Roche. The study included 105 HD patients. The clinical outcomes were determined after 2.5 years.
Considering the receiver operator characteristic (ROC) cutoff, the proportion of patients with elevated cTnI-B, cTnI-DB and cTnT levels was respectively 2%, 3% and 27%. The proportion of patients with abnormal cTn values increased when a lower cutoff value was considered, based on the 99th percentile of a reference population with a coefficient of variation of less than 10% (99th percentile-10% CV cutoff). The proportion of patients with elevated values did not differ before and after the HD session. The 2.5 years mortality was associated with increased levels of cTnT but not with increased levels of cTnI.
When the ROC cutoff is applied, cTnI assays are suitable for the monitoring of ACS in HD patients. cTnT could lead to false positive diagnosis of myocardial infarction, however it is predictive of long-term mortality. The 99th percentile-10% CV cutoff does not seem appropriate in HD patients.
由于肾衰竭本身被认为会导致心肌肌钙蛋白（cTn）水平升高，因此人们不愿将其用于监测血液透析（HD）患者的急性冠状动脉综合征（ACS）。本研究的目的是分析无ACS的HD患者中cTn水平升高的患者比例。
采用贝克曼公司的AccuTnI（商标）（cTnI-B）和达德拜林公司的肌钙蛋白I Stat（商标）（cTnI-DB）检测法测定cTnI；采用罗氏公司的第三代检测法测定cTnT。该研究纳入了105例HD患者。2.5年后确定临床结局。
根据受试者工作特征（ROC）临界值，cTnI-B、cTnI-DB和cTnT水平升高的患者比例分别为2%、3%和27%。基于变异系数小于10%的参考人群的第99百分位数（第99百分位数-10%CV临界值），当考虑较低的临界值时，cTn值异常的患者比例增加。HD治疗前后cTn值升高的患者比例没有差异。2.5年死亡率与cTnT水平升高有关，而与cTnI水平升高无关。
应用ROC临界值时，cTnI检测法适用于监测HD患者的ACS。cTnT可能导致心肌梗死的假阳性诊断，然而它可预测长期死亡率。第99百分位数-10%CV临界值在HD患者中似乎不合适。
