慢性肾衰竭患者的心肌肌钙蛋白 I 和肌酸激酶同工酶 MB。

Cardiac troponin I and creatine kinase MB isoenzyme in patients with chronic renal failure.

机构信息

Laboratorio de Análisis Clínicos. Complejo Hospitalario de Ourense, Spain.

出版信息

Nefrologia. 2012;32(6):809-18. doi: 10.3265/Nefrologia.pre2012.Jul.10986.

DOI:10.3265/Nefrologia.pre2012.Jul.10986

PMID:23169364

Abstract

OBJECTIVE

The aim of our study was to evaluate cut-off values for acute coronary syndrome (ACS) diagnosis in patients with chronic renal failure (CRF) for the cardiac biomarkers cardiac troponin I (cTnI) and creatine kinase MB isoenzyme (CK-MB) as compared to the cut-off values proposed by the manufacturers and those frequently used in the laboratory.

METHOD

We performed a prospective study in patients with CRF with a glomerular filtration rate estimated by the MDRD-4 equation <60 mL/min and admitted with suspected acute coronary syndrome due to clinical history, physical examination, and electrocardiography. cTnI and CK-MB measurements were assessed upon hospitalisation and six months later using two different analytical methods (for cTnI: Access® and Vidas® analysers, and for CK-MB: Access® and Vitros® analysers).

RESULTS

During the study period, 484 patients with CRF and suspected ACS were assessed. ACS was diagnosed in 12% of patients (58/484), while we found other cardiac pathologies (OCP) in 29% of patients (140/484) and other non-cardiac pathologies (ONCP) in 59% of patients (286/484). For cTnI assessed using the Access® analyser with the usual cut-off value (≥ 0.5 ng/mL), sensitivity was 43% and specificity was 94%, while for the proposed cut-off value (≥ 0.11 ng/mL), the values were 68% and 83%, respectively. For cTnI assessed using the Vidas® analyser with the usual cut-off value (≥ 0.11 ng/mL), sensitivity was 64% and specificity was 87%, while for the proposed cut-off value (≥ 0.06 ng/mL), the values were 75% and 79%, respectively. The sensitivity and specificity for both CK-MB were lower compared with cTnI.

CONCLUSION

The cut-off values proposed in this study for both cTnI in patients with CRF (stage 3 to 5) to diagnose ACS are significantly different from that of the general population.

摘要

目的

本研究旨在评估心脏标志物肌钙蛋白 I（cTnI）和肌酸激酶同工酶 MB（CK-MB）在慢性肾衰竭（CRF）患者中的急性冠状动脉综合征（ACS）诊断截断值，与制造商建议的截断值和实验室常用的截断值相比。

方法

我们对 MDRD-4 方程估算肾小球滤过率<60 mL/min 的 CRF 患者进行了前瞻性研究，并因临床病史、体格检查和心电图而怀疑患有急性冠状动脉综合征而入院。在入院时和 6 个月后使用两种不同的分析方法（cTnI：Access®和 Vidas®分析仪，CK-MB：Access®和 Vitros®分析仪）评估 cTnI 和 CK-MB 测量值。

结果

在研究期间，评估了 484 例 CRF 合并疑似 ACS 的患者。ACS 的诊断率为 12%（58/484），而我们发现其他心脏病变（OCP）在 29%的患者中（140/484），其他非心脏病变（ONCP）在 59%的患者中（286/484）。使用 Access®分析仪和常用截断值（≥0.5ng/mL）评估 cTnI 时，敏感性为 43%，特异性为 94%，而使用建议的截断值（≥0.11ng/mL）时，敏感性为 68%，特异性为 83%。使用 Vidas®分析仪和常用截断值（≥0.11ng/mL）评估 cTnI 时，敏感性为 64%，特异性为 87%，而使用建议的截断值（≥0.06ng/mL）时，敏感性为 75%，特异性为 79%。两种 CK-MB 的敏感性和特异性均低于 cTnI。