Pediatric Nephrology, Shaare Zedek Medical Center, The Hadassah-Hebrew University School of Medicine, Jerusalem, Israel.
Pediatr Nephrol. 2012 Apr;27(4):617-25. doi: 10.1007/s00467-011-2025-4. Epub 2011 Oct 27.
Myocardial damage and strain are common in children with chronic renal failure. The most prevalent pathologies, as defined by echocardiography, are left ventricular hypertrophy (LVH), diastolic and systolic dysfunction, and altered LV geometry. Troponin I and T, as well as B-type natriuretic peptide (BNP) and its cleavage fragment NT-proBNP, are known to be good markers of myocardial damage and stress, respectively, in the general adult population and among those with chronic kidney disease (CKD). In this study we measured the levels of troponins I and T, BNP, and NT-proBNP in a group of children and young adults with CKD stages 3-5 and determined their respective correlations with echocardiographic and laboratory abnormalities. BNP and NT-proBNP levels and their log values correlated well with the following parameters: diastolic blood pressure, estimated glomerular filtration rate, time-averaged hemoglobin levels, and LV mass. Both BNP and NT-proBNP levels, but not those of either troponin, were found to be reliable surrogate markers of strained hearts, defined as having LVH or diastolic or systolic dysfunction, in the pediatric CKD stages 3-4 group. The log NT-proBNP value was also found to be a good marker of cardiac strain in the CKD stage 5 group of patients. Serum BNP and NT-proBNP threshold concentrations of 43 and 529 pg/ml, respectively, were found to have the best sensitivity and specificity in predicting strained hearts. Based on these findings, we conclude that both BNP and NT-proBNP levels, but not those of troponins I and T, can serve as inexpensive, simple, and reliable markers of stressed hearts in the pediatric CKD patient population.
心肌损伤和应变在慢性肾衰竭儿童中很常见。超声心动图定义的最常见病变是左心室肥厚（LVH）、舒张和收缩功能障碍以及左心室几何形状改变。肌钙蛋白 I 和 T 以及 B 型利钠肽（BNP）及其裂解片段 NT-proBNP 在一般成年人群和慢性肾脏病（CKD）患者中分别被认为是心肌损伤和应激的良好标志物。在这项研究中，我们测量了一组 CKD 3-5 期儿童和年轻患者的肌钙蛋白 I 和 T、BNP 和 NT-proBNP 水平，并确定了它们与超声心动图和实验室异常的各自相关性。BNP 和 NT-proBNP 水平及其对数与以下参数密切相关：舒张压、估计肾小球滤过率、平均血红蛋白水平和左心室质量。在儿科 CKD 3-4 期患者中，BNP 和 NT-proBNP 水平（而非肌钙蛋白水平）均被发现是 LVH 或舒张或收缩功能障碍的紧张心脏的可靠替代标志物。NT-proBNP 对数值也被发现是 CKD 5 期患者心脏紧张的良好标志物。血清 BNP 和 NT-proBNP 分别为 43 和 529 pg/ml 的截断浓度被发现对预测紧张心脏具有最佳的敏感性和特异性。基于这些发现，我们得出结论，BNP 和 NT-proBNP 水平（而非肌钙蛋白 I 和 T 水平）可作为儿科 CKD 患者群体中紧张心脏的廉价、简单和可靠标志物。
