Helleskov Madsen Lene, Ladefoged Søren, Hildebrandt Per, Atar Dan
Department of Cardiology end Endocrinology, Frederiksberg University Hospital, Copenhagen, Denmark.
Acute Card Care. 2008;10(3):173-80. doi: 10.1080/17482940802100279.
Several studies have documented the importance of troponin elevation as a prognostic marker in end-stage renal disease (ESRD). The reason for the elevated concentrations is not clarified. We do not know whether the different assays recognize the same patients within ESRD populations. The aim of this study was to compare concentrations of troponin measured by four different assays in a cohort of patients with ESRD, to investigate whether haemodialysis affects troponin concentrations, and to compare the prognostic potential of the different assays.
We included 109 patients on chronic haemodialysis. Serum cardiac troponin T (cTnT) was measured pre- and postdialysis using Elecsys 2010 and troponin I (cTnI) using Access AccuTnI, Dimension RxL and AIA-600II.
The cTnT assay had the highest percentage of elevated concentrations for all chosen cut-offs with a reduction in percentage of patients with elevated concentrations during haemodialysis. Elecsys 2010 and AIA-600II demonstrated a significant increased mortality with raised concentrations of troponin.
The diverging results in previous studies are most likely based on substantial differences in the analytical performance of the assays. The prognostic value of cTnT appears superior to cTnI, which amplifies the prognostic significance of this cardiovascular marker in patients with ESRD.
多项研究记录了肌钙蛋白升高作为终末期肾病（ESRD）预后标志物的重要性。其浓度升高的原因尚不清楚。我们不知道不同的检测方法在ESRD患者群体中识别的是否为同一批患者。本研究的目的是比较在一组ESRD患者中通过四种不同检测方法测得的肌钙蛋白浓度，研究血液透析是否会影响肌钙蛋白浓度，并比较不同检测方法的预后潜力。
我们纳入了109例接受慢性血液透析的患者。使用Elecsys 2010在透析前和透析后测量血清心肌肌钙蛋白T（cTnT），并使用Access AccuTnI、Dimension RxL和AIA - 600II测量肌钙蛋白I（cTnI）。
对于所有选定的临界值，cTnT检测方法中浓度升高的百分比最高，且在血液透析期间浓度升高的患者百分比有所降低。Elecsys 2010和AIA - 600II显示，随着肌钙蛋白浓度升高，死亡率显著增加。
先前研究结果的差异很可能是基于检测方法分析性能的显著差异。cTnT的预后价值似乎优于cTnI，这进一步凸显了这种心血管标志物在ESRD患者中的预后意义。
