Corte Zoraida, García Camino, Venta Rafael
Service of Biochemistry, Hospital San Agustín, Avilés, Principado de Asturias, Spain.
Service of Nephrology, Hospital San Agustín, Avilés, Principado de Asturias, Spain.
Ann Clin Biochem. 2015 Jan;52(Pt 1):53-60. doi: 10.1177/0004563214545116. Epub 2014 Jul 8.
Serum cardiac troponin T concentrations are important predictors of cardiovascular and all-cause mortality in end-stage renal disease. In patients with end-stage renal disease, assessment of serial results is essential to distinguish between a cardiovascular event and chronic elevation. We employed a high-sensitivity serum cardiac troponin T assay to evaluate the long-term biological variation in end-stage renal disease patients and in healthy individuals; these biological variation data were used to define the reference change value and the analytical goals.
Serum samples were collected from 18 end-stage renal disease patients in steady-state conditions, one per month for 6 months, and from 11 healthy volunteers at weekly intervals over 5 weeks. Biological variation data were derived using analysis of variance.
Baseline serum cardiac troponin T concentrations in end-stage renal disease patients were above the 99th percentile of the healthy population and increased with duration of haemodialysis. For end-stage renal disease patients, within-subject (CVI) and between-subject (CVG) coefficients of variation were 14.7 and 77.8%, respectively, whereas these were 5.9 and 30.4%, respectively, for healthy individuals. The derived two-tailed and one-tailed reference change values were 44.1 and 37.1%, respectively, for end-stage renal disease patients, and 21.6 and 18.2% for healthy subjects.
For appropriate clinical management of end-stage renal disease patients in the context of a cardiovascular event, regular monitoring of serum cardiac troponin T concentrations could be important in order to allow future comparison through reference change value. Biological variation data in end-stage renal disease patients were significantly higher than for healthy individuals; therefore, the use of proper reference change value data is recommended. Moreover, the observed CVI values provide demanding imprecision goals for current technology.
血清心肌肌钙蛋白T浓度是终末期肾病患者心血管疾病及全因死亡率的重要预测指标。对于终末期肾病患者，评估系列检测结果对于区分心血管事件和慢性升高至关重要。我们采用高敏血清心肌肌钙蛋白T检测法评估终末期肾病患者及健康个体的长期生物学变异；这些生物学变异数据用于定义参考变化值和分析目标。
收集18例处于稳定状态的终末期肾病患者的血清样本，每月采集1次，共采集6个月；同时收集11名健康志愿者的血清样本，在5周内每周采集1次。采用方差分析得出生物学变异数据。
终末期肾病患者的基线血清心肌肌钙蛋白T浓度高于健康人群的第99百分位数，并随血液透析时间延长而升高。对于终末期肾病患者，个体内变异系数（CVI）和个体间变异系数（CVG）分别为14.7%和77.8%，而健康个体的这两个系数分别为5.9%和30.4%。终末期肾病患者得出的双侧和单侧参考变化值分别为44.1%和37.1%，健康受试者的分别为21.6%和18.2%。
为了在心血管事件背景下对终末期肾病患者进行适当的临床管理，定期监测血清心肌肌钙蛋白T浓度可能很重要，以便通过参考变化值进行未来比较。终末期肾病患者的生物学变异数据显著高于健康个体；因此，建议使用适当的参考变化值数据。此外，观察到的CVI值为当前技术提供了严格的不精密度目标。
