Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University of Tuebingen, Germany.
PLoS One. 2012;7(10):e47610. doi: 10.1371/journal.pone.0047610. Epub 2012 Oct 15.
In hemodialysis patients, elevated plasma troponin concentrations are a common finding that has even increased with the advent of newly developed sensitive assays. However, the interpretation and relevance of this is still under debate.
In this cross-sectional study, we analyzed plasma concentrations of sensitive troponin I (TnI) and troponin T (TnT) in stable ambulatory hemodialysis patients (n = 239) and investigated their associations with clinical factors and mortality.
In all of the enrolled patients, plasma TnI or TnT was detectable at a median concentration of 14 pg/ml (interquartile range: 7-29) using the Siemens TnI ultra assay and 49 pg/ml (31-74) using the Roche Elecsys high sensitive TnT assay. Markedly more patients exceeded the 99th percentile for TnT than for TnI (95% vs. 14%, p<0.0001). In a multivariate linear regression model, TnT was independently associated with age, gender, systolic dysfunction, time on dialysis, residual diuresis and systolic blood pressure, whereas TnI was independently associated with age, systolic dysfunction, pulse pressure, time on dialysis and duration of a HD session. During a follow-up period of nearly two years, TnT concentration above 38 pg/mL was associated with a 5-fold risk of death, whereas elevation of TnI had a gradual association to mortality.
In hemodialysis patients, elevations of plasma troponin concentrations are explained by cardiac function and dialysis-related parameters, which contribute to cardiac strain. Both are highly predictive of increased risk of death.
在血液透析患者中，升高的血浆肌钙蛋白浓度是一种常见现象，甚至随着新开发的高敏检测方法的出现而增加。然而，对此的解释和相关性仍存在争议。
在这项横断面研究中，我们分析了稳定的门诊血液透析患者（n=239）的血浆敏感肌钙蛋白 I（TnI）和肌钙蛋白 T（TnT）浓度，并研究了它们与临床因素和死亡率的关系。
在所有纳入的患者中，使用西门子 TnI 超高敏检测法，血浆 TnI 或 TnT 的中位数浓度为 14 pg/ml（四分位间距：7-29），而使用罗氏 Elecsys 高敏 TnT 检测法，浓度为 49 pg/ml（31-74）。显著更多的患者 TnT 超过了 TnT 的第 99 百分位数（95%比 14%，p<0.0001）。在多变量线性回归模型中，TnT 与年龄、性别、收缩功能障碍、透析时间、残余尿量和收缩压独立相关，而 TnI 与年龄、收缩功能障碍、脉压、透析时间和 HD 治疗时间独立相关。在近两年的随访期间，TnT 浓度超过 38 pg/ml 与死亡风险增加 5 倍相关，而 TnI 的升高与死亡率呈逐渐相关。
在血液透析患者中，血浆肌钙蛋白浓度的升高是由心脏功能和透析相关参数引起的，这些参数导致了心脏的紧张。两者都高度预测死亡风险增加。
