Hasegawa Midori, Ishii Junichi, Kitagawa Fumihiko, Kanayama Kyoko, Takahashi Hiroshi, Ozaki Yukio, Yuzawa Yukio
Department of Nephrology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutukaek-cho, Toyoake, Aichi, 470-1192, Japan.
Heart Vessels. 2013 Jul;28(4):473-9. doi: 10.1007/s00380-012-0273-2. Epub 2012 Aug 23.
Serum troponin T levels using a highly sensitive assay (hsTnT) in patients with chronic kidney disease (CKD) not on dialysis have not been examined. The aim of this prospective cohort study was to investigate the association of hsTnT with cardiac events in ambulatory CKD patients not on dialysis. The serum hsTnT level was measured in 442 ambulatory CKD patients not on dialysis whose estimated glomerular filtration rate was <60 ml/min/1.73 m(2). Patients were divided into quartiles according to hsTnT levels, and were followed up for 3 years. Cardiac events were defined as a cardiac death, acute myocardial infarction, unstable angina pectoris that required emergency coronary revascularization, or hospitalization for worsening heart failure. During the follow-up period (median 22 months), 63 cardiac events occurred. Kaplan-Meier incidence rates of cardiac events for 3 years were 0.88 %, 11.5 %, 19.0 %, and 41.4 % among quartiles of hsTnT levels (P < 0.0001). After adjusting for other confounders, elevated hsTnT level was an independent predictor for cardiac events (hazard ratio 6.18, 95 % confidence interval 1.38-27.7, P = 0.0080 for highest quartile vs lowest quartile). In addition, C-index for receiver-operating characteristic curves for cardiac events was greater in an established risks plus hsTnT model than in the established risk alone model (0.857 vs 0.844, P = 0.026). Using a highly sensitive assay, serum hsTnT level was shown to be an independent predictor of cardiac events and a promising risk stratification tool in patients with CKD not on dialysis.
尚未对未接受透析的慢性肾脏病（CKD）患者采用高敏检测法（hsTnT）检测血清肌钙蛋白T水平。这项前瞻性队列研究的目的是调查hsTnT与未接受透析的非卧床CKD患者心脏事件之间的关联。对442例估算肾小球滤过率<60 ml/min/1.73 m²的未接受透析的非卧床CKD患者测定血清hsTnT水平。根据hsTnT水平将患者分为四分位数，并随访3年。心脏事件定义为心源性死亡、急性心肌梗死、需要紧急冠状动脉血运重建的不稳定型心绞痛或因心力衰竭加重而住院。在随访期间（中位时间22个月），发生了63例心脏事件。hsTnT水平四分位数组的3年心脏事件Kaplan-Meier发生率分别为0.88%、11.5%、19.0%和41.4%（P<0.0001）。在对其他混杂因素进行校正后，hsTnT水平升高是心脏事件的独立预测因素（最高四分位数与最低四分位数相比，风险比6.18，95%置信区间1.38-27.7，P=0.0080）。此外，在既定风险加hsTnT模型中，心脏事件的受试者工作特征曲线的C指数高于仅基于既定风险的模型（0.857对0.844，P=0.026）。采用高敏检测法显示，血清hsTnT水平是未接受透析的CKD患者心脏事件的独立预测因素，也是一种很有前景的风险分层工具。
