Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD 21201, USA.
Clin Chem. 2012 Sep;58(9):1342-51. doi: 10.1373/clinchem.2012.185322. Epub 2012 Jul 12.
Quantification and comparison of high-sensitivity (hs) cardiac troponin I (cTnI) and cTnT concentrations in chronic kidney disease (CKD) have not been reported. We examined the associations between hs cTnI and cTnT, cardiovascular disease, and renal function in outpatients with stable CKD.
Outpatients (n = 148; 16.9% with prior myocardial infarction or coronary revascularization) with an estimated glomerular filtration rate (eGFR) of <60 mL · min⁻¹ · (1.73 m²)⁻¹ had serum cTnI (99th percentile of a healthy population = 9.0 ng/L), and cTnT (99th percentile = 14 ng/L) measured with hs assays. Left ventricular ejection fraction (LVEF) and mass were assessed by echocardiography, and coronary artery calcification (CAC) was determined by computed tomography. Renal function was estimated by eGFR and urine albumin/creatinine ratio (UACR).
The median (interquartile range) concentrations of cTnI and cTnT were 6.3 (3.4-14.4) ng/L and 17.0 (11.2-31.4) ng/L, respectively; 38% and 68% of patients had a cTnI and cTnT above the 99th percentile, respectively. The median CAC score was 80.8 (0.7-308.6), LV mass index was 85 (73-99) g/m², and LVEF was 58% (57%-61%). The prevalences of prior coronary disease events, CAC score, and LV mass index were higher with increasing concentrations from both hs cardiac troponin assays (P < 0.05 for all). After adjustment for demographics and risk factors, neither cardiac troponin assay was associated with CAC, but both remained associated with LV mass index as well as eGFR and UACR.
Increased hs cTnI and cTnT concentrations are common in outpatients with stable CKD and are influenced by both underlying cardiac and renal disease.
目前尚未有关于慢性肾脏病（CKD）患者高敏（hs）心肌肌钙蛋白 I（cTnI）和 cTnT 浓度的定量和比较研究。本研究旨在探讨门诊稳定 CKD 患者 hs cTnI 和 cTnT 浓度与心血管疾病和肾功能之间的关系。
本研究纳入了肾小球滤过率（eGFR）<60 mL·min⁻¹·（1.73 m²）⁻¹的门诊患者（16.9%的患者有既往心肌梗死或冠状动脉血运重建病史），检测了 hs 检测方法下的血清 cTnI（健康人群第 99 百分位数=9.0ng/L）和 cTnT（第 99 百分位数=14ng/L）。通过超声心动图评估左心室射血分数（LVEF）和质量，通过计算机断层扫描（CT）确定冠状动脉钙化（CAC）。通过 eGFR 和尿白蛋白/肌酐比值（UACR）估计肾功能。
cTnI 和 cTnT 的中位数（四分位间距）浓度分别为 6.3（3.4-14.4）ng/L 和 17.0（11.2-31.4）ng/L；分别有 38%和 68%的患者 cTnI 和 cTnT 浓度高于第 99 百分位数。CAC 评分的中位数为 80.8（0.7-308.6），左心室质量指数为 85（73-99）g/m²，LVEF 为 58%（57%-61%）。随着 hs 心肌肌钙蛋白检测浓度的升高，既往冠状动脉疾病事件、CAC 评分和左心室质量指数的发生率均升高（所有 P<0.05）。在校正了人口统计学和危险因素后，两种心肌肌钙蛋白检测均与 CAC 无关，但仍与左心室质量指数以及 eGFR 和 UACR 相关。
hs cTnI 和 cTnT 浓度升高在稳定 CKD 的门诊患者中很常见，并且受潜在的心脏和肾脏疾病的影响。
