Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, PO Box 30.001 AA53, 9700 RB, Groningen, The Netherlands.
Eur Heart J. 2012 Sep;33(18):2272-81. doi: 10.1093/eurheartj/ehs163. Epub 2012 Jun 27.
It has been suggested that troponins and natriuretic peptides can be falsely elevated in subjects with impaired kidney function because of decreased renal clearance. The value of these biomarkers in subjects with impaired kidney function has therefore been debated. We tested in a population-based cohort study, first, whether high-sensitive troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels are cross-sectionally associated with the estimated glomerular filtration rate (eGFR) and albuminuria, and secondly, whether these markers are associated with cardiovascular outcome, independent of eGFR, albuminuria and conventional cardiovascular risk factors.
We included 8121 subjects from the PREVEND study with both values of hsTnT and NT-pro-BNP available. High-sensitive troponin T >0.01 µg/L and NT-pro-BNP >125 ng/L were defined as elevated. We first performed linear regression analyses with hsTnT and NT-pro-BNP as dependent variables. Next, we performed Cox-regression analyses, studying the associations of hsTnT and NT-pro-BNP with incident cardiovascular events. Of our cohort, 6.7% had an elevated hsTnT and 12.2% an elevated NT-pro-BNP. Also, the estimated glomerular filtration rate, albuminuria, and ECG-assessed ischaemia and left ventricular hypertrophy were all significantly associated with hsTnT and NT-pro-BNP in the linear regression analyses. Both hsTnT and NT-pro-BNP appeared associated with cardiovascular events, and these associations remained significant after adjustment for eGFR, albuminuria, age, gender and conventional cardiovascular risk factors (P= 0.03 and P< 0.001, respectively). Only a few subjects with markedly reduced renal function were included. The results presented are therefore mainly valid for a population with mildly impaired renal function.
These data indicate that a finding of an increased hsTnT or NT-pro-BNP in subjects with chronic kidney disease stages 1/3 should be taken seriously as a prognostic marker for a worse cardiovascular outcome and not be discarded as merely a reflection of decreased renal clearance.
有人认为，由于肾功能下降导致肾脏清除率降低，肌钙蛋白和利钠肽可能在肾功能受损的患者中出现假性升高。因此，这些生物标志物在肾功能受损患者中的价值一直存在争议。我们在一项基于人群的队列研究中首先检验了高敏肌钙蛋白 T（hsTnT）和 N 末端 pro-B 型利钠肽（NT-pro-BNP）水平是否与估算肾小球滤过率（eGFR）和白蛋白尿呈横断面相关，其次检验了这些标志物是否与心血管结局相关，而与 eGFR、白蛋白尿和传统心血管危险因素无关。
我们纳入了 PREVEND 研究中 8121 例同时具有 hsTnT 和 NT-pro-BNP 值的患者。将 hsTnT>0.01μg/L 和 NT-pro-BNP>125ng/L 定义为升高。我们首先进行了线性回归分析，将 hsTnT 和 NT-pro-BNP 作为因变量。接下来，我们进行了 Cox 回归分析，研究 hsTnT 和 NT-pro-BNP 与心血管事件发生的相关性。在我们的队列中，6.7%的患者 hsTnT 升高，12.2%的患者 NT-pro-BNP 升高。此外，在线性回归分析中，估算肾小球滤过率、白蛋白尿以及心电图评估的缺血和左心室肥厚均与 hsTnT 和 NT-pro-BNP 显著相关。hsTnT 和 NT-pro-BNP 均与心血管事件相关，这些相关性在调整 eGFR、白蛋白尿、年龄、性别和传统心血管危险因素后仍然显著（P=0.03 和 P<0.001）。仅纳入了少数肾功能明显降低的患者。因此，本研究结果主要适用于肾功能轻度受损的人群。
这些数据表明，在慢性肾脏病 1/3 期患者中发现 hsTnT 或 NT-pro-BNP 升高应被视为心血管预后不良的预后标志物，而不应因其仅仅反映肾脏清除率降低而被忽视。
