Montagnana Martina, Lippi Giuseppe, Tessitore Nicola, Salvagno Gian Luca, Targher Giovanni, Gelati Matteo, Lupo Antonio, Guidi Gian Cesare
Sezione di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Ospedale Policlinico G.B. Rossi, Verona, Italy.
J Clin Lab Anal. 2008;22(1):59-65. doi: 10.1002/jcla.20210.
The diagnostic approach to acute coronary syndrome (ACS) is challenging in patients with impaired renal function since most serum biomarkers are commonly increased in this clinical setting. Cardiac troponin T (cTnT), creatine kinase isoenzyme MB (CK MB), myoglobin, and ischemia modified albumin (IMA), were assayed in 45 patients prehemodialysis (pre-HD) and posthemodialysis (post-HD), and results were adjusted for hemoconcentration. The pre-HD values of serum IMA and cTnT were above the respective diagnostic thresholds (IMA<85 K units/L; cTnT <0.03 ng/mL) in six (13%) and 27 (60%) patients undergoing chronic HD, respectively. A significant (105.0 vs. 79.0 K units/L, P<0.0001) and variable (+38%; 95% confidence interval [CI], 12-65%) increase of serum IMA was observed post-HD, whereas the other biomarkers significantly decreased (cTnT: 0.029 vs. 0.044 ng/mL, P=0.016; CK-MB: 2.33 vs. 2.50 microg/L, P<0.0001; myoglobin: 128.1 vs. 148.7 microg/L, P<0.0001). Biomarkers of myocardial injury, especially cTnT and IMA, might be used in HD patients, provided that an appropriate diagnostic interpretation is guarantee, according to individual baseine value, metabolism, and time of sampling. Moreover, IMA might be reliably applied to stratify the long-term risk of these patients, but not for diagnosing an ACS during or immediately post-HD.
对于肾功能受损的患者，急性冠状动脉综合征（ACS）的诊断方法具有挑战性，因为在这种临床情况下大多数血清生物标志物通常会升高。对45例血液透析前（HD前）和血液透析后（HD后）的患者进行了心肌肌钙蛋白T（cTnT）、肌酸激酶同工酶MB（CK MB）、肌红蛋白和缺血修饰白蛋白（IMA）的检测，并对结果进行了血液浓缩校正。在接受慢性血液透析的患者中，HD前血清IMA和cTnT值分别在6例（13%）和27例（60%）患者中高于各自的诊断阈值（IMA<85 K单位/L；cTnT<0.03 ng/mL）。HD后观察到血清IMA显著升高（105.0对79.0 K单位/L，P<0.0001）且变化较大（增加38%；95%置信区间[CI]，12-65%），而其他生物标志物显著降低（cTnT：0.029对0.044 ng/mL，P=0.016；CK-MB：2.33对2.50 μg/L，P<0.0001；肌红蛋白：128.1对148.7 μg/L，P<0.0001）。只要根据个体基线值、代谢和采样时间保证适当的诊断解释，心肌损伤生物标志物，尤其是cTnT和IMA，可用于血液透析患者。此外，IMA可能可靠地用于分层这些患者的长期风险，但不适用于在血液透析期间或刚结束后诊断ACS。
