Avouac Jérôme, Meune Christophe, Chenevier-Gobeaux Camille, Borderie Didier, Lefevre Guillaume, Kahan André, Allanore Yannick
Paris Descartes University, Sorbonne Paris Cité, Cochin Hospital, and Paris Descartes University, INSERM U1016 and CNRS UMR8104, Cochin Institute, Paris, France.
Paris 13 University, University Hospital of Paris-Seine-Saint-Denis, Bobigny, France and UMR 942, Paris, France.
Arthritis Care Res (Hoboken). 2015 Jul;67(7):1022-30. doi: 10.1002/acr.22547.
To measure plasma concentrations of high-sensitivity cardiac troponin T (HS-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with systemic sclerosis (SSc; scleroderma) and age- and sex-matched healthy control subjects, and to examine the contribution of traditional cardiovascular risk factors and SSc features to the concentrations of these 2 cardiac biomarkers.
Plasma HS-cTnT and NT-proBNP concentrations were measured using the electrochemiluminescence method and sandwich immunoassay, respectively.
The study group comprised 161 unrelated patients with SSc and 213 matched control subjects. HS-cTnT and NT-proBNP plasma levels were significantly increased in SSc patients compared with controls (both P < 0.001). Similar results were observed in the subgroup of patients with SSc who had no cardiovascular risk factors (n = 72). Multivariate logistic regression analysis confirmed diabetes mellitus (P = 0.006), high blood pressure (P = 0.021), precapillary pulmonary hypertension (P = 0.039), and the diffuse cutaneous SSc (P = 0.004) as factors independently associated with an HS-cTnT level of >14 ng/liter. Increased NT-proBNP concentrations were associated only with the presence of precapillary pulmonary hypertension (P < 0.001). Normal concentrations of both HS-cTnT and NT-proBNP had a high negative predictive value for precapillary pulmonary hypertension (92%), and the combination of increased values of these 2 markers had the highest strength of association with precapillary pulmonary hypertension in logistic regression analysis.
HS-cTnT and NT-proBNP concentrations are increased in patients with SSc, even in those who are free of cardiovascular risk factors. These easily obtained biomarkers may be useful for systematic evaluation and stratification of SSc patients, especially to identify those at risk of pulmonary hypertension.
测定系统性硬化症（SSc；硬皮病）患者及年龄和性别匹配的健康对照者血浆中高敏心肌肌钙蛋白T（HS-cTnT）和N末端脑钠肽前体（NT-proBNP）的浓度，并研究传统心血管危险因素和SSc特征对这两种心脏生物标志物浓度的影响。
分别采用电化学发光法和夹心免疫分析法测定血浆HS-cTnT和NT-proBNP浓度。
研究组包括161例无亲缘关系的SSc患者和213例匹配的对照者。与对照组相比，SSc患者的HS-cTnT和NT-proBNP血浆水平显著升高（均P < 0.001）。在无心血管危险因素的SSc患者亚组（n = 72）中也观察到类似结果。多因素逻辑回归分析证实，糖尿病（P = 0.006）、高血压（P = 0.021）、毛细血管前肺动脉高压（P = 0.（此处原文有误，应为0.039））和弥漫性皮肤型SSc（P = 0.004）是与HS-cTnT水平>14 ng/升独立相关的因素。NT-proBNP浓度升高仅与毛细血管前肺动脉高压的存在相关（P < 0.001）。HS-cTnT和NT-proBNP浓度正常对毛细血管前肺动脉高压具有较高的阴性预测价值（92%），在逻辑回归分析中，这两种标志物升高值的组合与毛细血管前肺动脉高压的关联强度最高。
SSc患者的HS-cTnT和NT-proBNP浓度升高，即使是那些没有心血管危险因素的患者。这些易于获得的生物标志物可能有助于对SSc患者进行系统评估和分层，尤其是识别有肺动脉高压风险的患者。
