Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
Am J Kidney Dis. 2013 Jan;61(1):67-73. doi: 10.1053/j.ajkd.2012.06.022. Epub 2012 Aug 9.
Detectable levels of cardiac troponins are common in individuals with chronic kidney disease (CKD), even in the absence of symptomatic cardiovascular disease. Abnormal cardiac troponin values are associated with coronary artery disease and left ventricular hypertrophy (LVH) and predict poor clinical outcomes. Elevated levels of fibroblast growth factor 23 (FGF-23) contribute to LVH in CKD. We investigated the association of FGF-23 and hs-cTnI (high-sensitivity cardiac troponin I) and hs-cTnT (high-sensitivity cardiac troponin T) levels in CKD and examined the role of LVH in this association.
Cross-sectional observational study.
SETTING & PARTICIPANTS: 153 stable outpatients with non-dialysis-dependent CKD.
The primary predictor was FGF-23 level.
hs-cTnI, hs-cTnT.
FGF-23, hs-cTnI, hs-cTnT; left ventricular mass index (LVMI) assessed by echocardiography; coronary artery calcification (CAC) measured by computed tomography. LVMI and CAC were evaluated as potential mediators of the effect of FGF-23 on hs-cTnI/T.
Mean age was 64 ± 12 (SD) years, mean estimated glomerular filtration rate was 34 ± 11 mL/min/1.73 m(2), median FGF-23 level was 120 (25th-75th percentile, 79-223) reference unit (RU)/mL, median hs-cTnI level was 6.5 (25th-75th percentile, 3.5-14.5) pg/mL, and median hs-cTnT level was 16.8 (25th-75th percentile, 11.1-33.9) pg/mL. cTnI and cTnT concentrations were higher than the 99th percentile of a healthy population in 42% and 61% of patients, respectively. In unadjusted and multivariable-adjusted analyses, hs-cTnI/T levels were associated significantly with FGF-23 levels. Adjusting for LVMI, but not CAC, weakened the association of FGF-23 and hs-cTnI/T levels.
Vitamin D levels were not measured. The prevalence of coronary artery disease may have been underestimated because it was ascertained by self-report.
Minimally elevated cTnI and cTnT levels, detectable by high-sensitivity assays, are associated with elevated FGF-23 levels in stable outpatients with CKD. FGF-23-associated LVH may contribute to detectable hs-cTnI/T levels observed in non-dialysis-dependent patients with CKD.
即使在没有症状性心血管疾病的情况下，慢性肾脏病（CKD）患者的心肌肌钙蛋白水平也普遍升高。异常的心肌肌钙蛋白值与冠状动脉疾病和左心室肥厚（LVH）有关，并预测临床预后不良。成纤维细胞生长因子 23（FGF-23）水平升高导致 CKD 中的 LVH。我们研究了 FGF-23 和高敏心肌肌钙蛋白 I（hs-cTnI）和高敏心肌肌钙蛋白 T（hs-cTnT）水平在 CKD 中的相关性，并检查了 LVH 在这种相关性中的作用。
横断面观察性研究。
153 名非透析依赖型 CKD 的稳定门诊患者。
主要预测因子是 FGF-23 水平。
hs-cTnI、hs-cTnT；通过超声心动图评估左心室质量指数（LVMI）；通过计算机断层扫描测量冠状动脉钙化（CAC）。LVMI 和 CAC 被评估为 FGF-23 对 hs-cTnI/T 影响的潜在介质。
未测量维生素 D 水平。由于通过自我报告确定，因此可能低估了冠状动脉疾病的患病率。
稳定的 CKD 门诊患者中，通过高敏检测方法可检测到轻度升高的 cTnI 和 cTnT 水平，与升高的 FGF-23 水平相关。FGF-23 相关的 LVH 可能导致非透析依赖型 CKD 患者出现可检测到的 hs-cTnI/T 水平。
