高敏肌钙蛋白 T 提高稳定性冠状动脉疾病患者 N 末端 pro-B 型利钠肽的预后价值：来自 LURIC 研究的结果。

High-sensitivity troponin T improves the prognostic value of N-terminal pro-B-type natriuretic peptide in patients with stable coronary artery disease: results from the LURIC Study.

机构信息

Synlab Medical Center Heidelberg GmbH, Heidelberg, Germany.

出版信息

Clin Chem Lab Med. 2011 Jun;49(6):1053-8. doi: 10.1515/CCLM.2011.176. Epub 2011 May 17.

DOI:10.1515/CCLM.2011.176

PMID:21574877

Abstract

BACKGROUND

Cardiac troponin T is an established prognostic marker in patients with acute coronary syndromes, but not in stable coronary artery disease (CAD) like N-terminal pro-B-type natriuretic peptide (NT-proBNP). We examined the additive prognostic value of a high-sensitivity troponin T (hsTnT) assay to predict adverse clinical outcomes in stable CAD.

METHODS

A retrospective nested case-control analysis of 256 patients with stable CAD who participated in the LURIC study: 128 cases who died from cardiovascular causes during a median follow-up of 7.5 years and 128 survivors (controls) matched for age and gender, were included. hsTnT and NT-proBNP were determined in baseline samples using immunoassays (Roche Diagnostics, Germany).

RESULTS

Sixty-two percent of the 256 subjects exhibited concentrations of hsTnT≥14 ng/L, the manufacturer recommended cut-off to diagnose myocardial infarction in patients with acute chest pain. hsTnT, NT-proBNP, diabetes mellitus and fasting glucose were associated with cardiovascular mortality in univariate analysis. Logistic regression identified hsTnT and NT-proBNP as independent risk markers. Receiver operator characteristic (ROC) curves analysis identified optimal cut-offs at 15 ng/L and 352 μg/L for hsTnT (AUC 0.728, p<0.05) and NT-proBNP (AUC 0.751, p=0.07), respectively. Patients with one or two positive markers exhibited 5-year cardiovascular mortalities of 40% and 60%, respectively, compared to 10% in patients with negative markers. The addition of hsTnT to NT-proBNP significantly increased c-statistics of proportional hazards calculated from survival times as well as net reclassification indexes.

CONCLUSIONS

Many patients with stable CAD exhibited increased concentrations of hsTnT. The combined determination of NT-proBNP and hsTnT was superior for risk stratification compared to determining either marker alone.

摘要

背景

心肌肌钙蛋白 T 是急性冠状动脉综合征患者的既定预后标志物，但在稳定性冠状动脉疾病（CAD）中并非如此，如 N 末端脑利钠肽前体（NT-proBNP）。我们研究了高敏肌钙蛋白 T（hsTnT）检测在预测稳定性 CAD 不良临床结局方面的额外预后价值。

方法

对参加 LURIC 研究的 256 例稳定性 CAD 患者进行回顾性巢式病例对照分析：中位随访 7.5 年后，128 例患者因心血管原因死亡（病例组），并按年龄和性别匹配 128 例存活患者（对照组）。使用免疫测定法（罗氏诊断公司，德国）在基线样本中测定 hsTnT 和 NT-proBNP。

结果

256 例受试者中 62%的 hsTnT 浓度≥14ng/L，这是制造商推荐用于诊断急性胸痛患者心肌梗死的截断值。hsTnT、NT-proBNP、糖尿病和空腹血糖在单因素分析中与心血管死亡率相关。逻辑回归确定 hsTnT 和 NT-proBNP 为独立风险标志物。受试者工作特征（ROC）曲线分析确定了 hsTnT 和 NT-proBNP 的最佳截断值分别为 15ng/L 和 352μg/L（hsTnT 的 AUC 为 0.728，p<0.05；NT-proBNP 的 AUC 为 0.751，p=0.07）。与阴性标志物患者相比，有一个或两个阳性标志物的患者 5 年心血管死亡率分别为 40%和 60%，而阴性标志物患者为 10%。hsTnT 与 NT-proBNP 的联合测定显著提高了基于生存时间计算的比例风险的 c 统计量和净重新分类指数。