Wang Angela Yee-Moon, Lam Christopher Wai-Kei, Wang Mei, Chan Iris Hiu-Shuen, Lui Siu-Fai, Zhang Yan, Sanderson John E
Department of Medicine & Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
Nephrol Dial Transplant. 2009 Jun;24(6):1962-9. doi: 10.1093/ndt/gfp067. Epub 2009 Feb 23.
N-terminal-pro-brain natriuretic peptide, cardiac troponin T (cTnT) and high sensitivity C-reactive protein (hs-CRP) have been shown to predict mortality and cardiovascular outcomes in end-stage renal disease patients. However, it is not known which biomarkers have the strongest diagnostic potential for left ventricular (LV) abnormalities in chronic peritoneal dialysis (PD) patients, nor whether residual renal function may confound the diagnostic potential of these biomarkers.
Two hundred and thirty chronic PD patients underwent two-dimensional echocardiography to determine LV hypertrophy and ejection fraction and had simultaneous measurement of serum NT-pro-BNP, cTnT and hs-CRP.
A significant gain in predictive power was observed when NT-pro-BNP or cTnT but not hs-CRP was included in the multivariable logistic regression models for severe LV hypertrophy (defined as LV mass index > or = upper tertile, 247.8 g/m(2)) and systolic dysfunction (defined as ejection fraction < or =45%). Using ROC curve analysis, NT-pro-BNP had the highest diagnostic value for severe LV hypertrophy and systolic dysfunction compared to cTnT and hs-CRP, irrespective of residual renal function. An analysis based on the best cut-off threshold showed that NT-pro-BNP and cTnT had a negative predictive value of 87.1% and 92.6% for severe LV hypertrophy and 95.4% and 93.2% for systolic dysfunction, respectively. Furthermore, the best cut-off threshold of NT-pro-BNP and cTnT for excluding severe LV hypertrophy and systolic dysfunction was nearly 3-fold higher in anuric patients than in patients with residual renal function.
Serum NT-pro-BNP appeared most useful in excluding systolic dysfunction in chronic PD patients followed by cTnT. hs-CRP was not useful in this regard. Residual renal function confounded the interpretation of these biomarkers and reduced their predictive power. A nearly 30% higher cut-off threshold of NT-pro-BNP and cTnT had to be applied in anuric PD patients.
N 末端脑钠肽前体、心肌肌钙蛋白 T（cTnT）和高敏 C 反应蛋白（hs-CRP）已被证明可预测终末期肾病患者的死亡率和心血管结局。然而，尚不清楚哪些生物标志物对慢性腹膜透析（PD）患者左心室（LV）异常具有最强的诊断潜力，也不清楚残余肾功能是否会混淆这些生物标志物的诊断潜力。
230 例慢性 PD 患者接受二维超声心动图检查以确定左心室肥厚和射血分数，并同时测量血清 NT-pro-BNP、cTnT 和 hs-CRP。
在多变量逻辑回归模型中，对于严重左心室肥厚（定义为左心室质量指数≥上三分位数，247.8 g/m²）和收缩功能障碍（定义为射血分数≤45%），当纳入 NT-pro-BNP 或 cTnT 而非 hs-CRP 时，观察到预测能力有显著提高。使用 ROC 曲线分析，无论残余肾功能如何，与 cTnT 和 hs-CRP 相比，NT-pro-BNP 对严重左心室肥厚和收缩功能障碍具有最高的诊断价值。基于最佳截断阈值的分析表明，NT-pro-BNP 和 cTnT 对严重左心室肥厚的阴性预测值分别为 87.1%和 92.6%，对收缩功能障碍的阴性预测值分别为 95.4%和 93.2%。此外，无尿患者中 NT-pro-BNP 和 cTnT 排除严重左心室肥厚和收缩功能障碍的最佳截断阈值比有残余肾功能的患者高近 3 倍。
血清 NT-pro-BNP 在排除慢性 PD 患者收缩功能障碍方面似乎最有用，其次是 cTnT。hs-CRP 在这方面无用。残余肾功能混淆了这些生物标志物的解释并降低了它们的预测能力。在无尿的 PD 患者中，必须应用比 NT-pro-BNP 和 cTnT 高近 30%的截断阈值。
