School of Graduate Entry Medicine and Health, University of Nottingham Medical School at Derby and Department of Renal Medicine, Royal Derby Hospital, Derby, United Kingdom.
Clin J Am Soc Nephrol. 2012 Aug;7(8):1285-92. doi: 10.2215/CJN.00460112. Epub 2012 Jul 19.
Circulating troponin T levels are frequently elevated in patients undergoing long-term dialysis. The pathophysiology underlying these elevations is controversial.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In 70 prevalent hemodialysis (HD) patients, HD-induced myocardial stunning was assessed echocardiographically at baseline and after 12 months. Nineteen patients were not available for the follow-up analysis. The extent to which predialysis troponin T was associated with the occurrence of HD-induced myocardial stunning was assessed as the primary endpoint.
The median troponin T level in this hemodialysis cohort was 0.06 ng/ml (interquartile range, 0.02-0.10). At baseline, 64% of patients experienced myocardial stunning. These patients showed significantly higher troponin T levels than patients without stunning (0.08 ng/ml [0.05-0.12] versus 0.02 ng/ml [0.01-0.05]). Troponin T levels were significantly correlated to measures of myocardial stunning severity (number of affected segments: r=0.42; change in ejection fraction from beginning of dialysis to end of dialysis: r=-0.45). In receiver-operating characteristic analyses, predialytic troponin T achieved an area under the curve of 0.82 for the detection of myocardial stunning. In multivariable analysis, only ultrafiltration volume (odds ratio, 4.38 for every additional liter) and troponin T (odds ratio, 9.33 for every additional 0.1 ng/ml) were independently associated with myocardial stunning. After 12 months, nine patients had newly developed myocardial stunning and showed a significant increase in troponin T over baseline (0.03 ng/ml at baseline versus 0.05 ng/ml at year 1).
Troponin T levels in HD patients are associated with the presence and severity of HD-induced myocardial stunning.
长期接受血液透析的患者循环肌钙蛋白 T 水平经常升高。这些升高的病理生理学基础存在争议。
设计、地点、参与者和测量方法：在 70 例现患血液透析（HD）患者中，在基线和 12 个月时通过超声心动图评估 HD 诱导的心肌顿抑。19 例患者无法进行随访分析。将基线时肌钙蛋白 T 与 HD 诱导的心肌顿抑发生的相关性评估为主要终点。
该血液透析队列的肌钙蛋白 T 中位数为 0.06ng/ml（四分位间距，0.02-0.10）。基线时，64%的患者发生心肌顿抑。这些患者的肌钙蛋白 T 水平明显高于无顿抑的患者（0.08ng/ml[0.05-0.12]比 0.02ng/ml[0.01-0.05]）。肌钙蛋白 T 水平与心肌顿抑严重程度的测量值显著相关（受影响节段数：r=0.42；从透析开始到透析结束时射血分数的变化：r=-0.45）。在接受者操作特征分析中，透析前肌钙蛋白 T 对心肌顿抑的检测曲线下面积为 0.82。在多变量分析中，只有超滤量（每增加 1 升的比值比，4.38）和肌钙蛋白 T（每增加 0.1ng/ml 的比值比，9.33）与心肌顿抑独立相关。12 个月后，9 例患者新发生心肌顿抑，与基线相比肌钙蛋白 T显著升高（基线时 0.03ng/ml，第 1 年时 0.05ng/ml）。
HD 患者的肌钙蛋白 T 水平与 HD 诱导的心肌顿抑的存在和严重程度相关。
