患有和未患有慢性冠状动脉疾病的糖尿病患者体内的肌钙蛋白
Troponin in diabetic patients with and without chronic coronary artery disease.
作者信息
Segre Carlos Alexandre Wainrober, Hueb Whady, Garcia Rosa Maria Rahmi, Rezende Paulo Cury, Favarato Desiderio, Strunz Celia Maria Cassaro, Sprandel Marília da Costa Oliveira, Roggério Alessandra, Carvalho Ana Luiza de Oliveira, Maranhão Raul Cavalcante, Ramires José Antonio Franchini, Kalil Filho Roberto
机构信息
Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, BL I, Sala 114, Cerqueira César, Sao Paulo, SP, 05403-000, Brazil.
出版信息
BMC Cardiovasc Disord. 2015 Jul 21;15:72. doi: 10.1186/s12872-015-0051-z.
BACKGROUND
Cardiac-specific troponin detected with the new high-sensitivity assays can be chronically elevated in response to cardiovascular comorbidities and confer important prognostic information, in the absence of unstable coronary syndromes. Both diabetes mellitus and coronary artery disease are known predictors of troponin elevation. It is not known whether diabetic patients with coronary artery disease have different levels of troponin compared with diabetic patients with normal coronary arteries. To investigate this question, we determined the concentrations of a level 1 troponin assay in two groups of diabetic patients: those with multivessel coronary artery disease and those with angiographically normal coronary arteries.
METHODS
We studied 95 diabetic patients and compared troponin in serum samples from 50 patients with coronary artery disease (mean age = 63.7, 58 % male) with 45 controls with angiographically normal coronary arteries. Brain natriuretic peptide and the oxidative stress biomarkers myeloperoxidase, nitrotyrosine and oxidized LDL were also determined.
RESULTS
Diabetic patients with coronary artery disease had higher levels of troponin than did controls (median values, 12.0 pg/mL (95 % CI:10-16) vs 7.0 pg/mL (95 % CI: 5.9-8.5), respectively; p = 0.0001). The area under the ROC curve for the diagnosis of CAD was 0.712 with a sensitivity of 70 % and a specificity of 66 %. Plasma BNP levels and oxidative stress variables (myeloperoxidase, nitrotyrosine, and oxidized LDL) were not different between the two groups. In a multivariate analysis, gender (p = 0.04), serum glucose (0.03) and Troponin I (p = 0.01) had independent statistical significance.
CONCLUSION
Troponin elevation is related to the presence of chronic coronary artery disease in diabetic patients with multiple associated cardiovascular risk factors. Troponin may serve as a biomarker in this high-risk population.
TRIAL REGISTRATION
http://www.controlled-trials.com
REGISTRATION NUMBER
ISRCTN26970041.
背景
采用新型高灵敏度检测方法检测到的心脏特异性肌钙蛋白，在无不稳定型冠状动脉综合征的情况下，可因心血管合并症而长期升高，并提供重要的预后信息。糖尿病和冠状动脉疾病均为肌钙蛋白升高的已知预测因素。目前尚不清楚合并冠状动脉疾病的糖尿病患者与冠状动脉正常的糖尿病患者的肌钙蛋白水平是否存在差异。为研究这一问题，我们测定了两组糖尿病患者的一级肌钙蛋白检测浓度：多支冠状动脉疾病患者和冠状动脉造影正常的患者。
方法
我们研究了95例糖尿病患者，并比较了50例冠状动脉疾病患者（平均年龄63.7岁，58%为男性）与45例冠状动脉造影正常的对照者血清样本中的肌钙蛋白。还测定了脑钠肽以及氧化应激生物标志物髓过氧化物酶、硝基酪氨酸和氧化型低密度脂蛋白。
结果
合并冠状动脉疾病的糖尿病患者的肌钙蛋白水平高于对照组（中位数分别为12.0 pg/mL（95%CI：10 - 16）和7.0 pg/mL（95%CI：5.9 - 8.5）；p = 0.0001）。诊断冠心病的ROC曲线下面积为0.712，灵敏度为70%，特异性为66%。两组间血浆BNP水平和氧化应激变量（髓过氧化物酶、硝基酪氨酸和氧化型低密度脂蛋白）无差异。在多变量分析中，性别（p = 0.04）、血糖（0.03）和肌钙蛋白I（p = 0.01）具有独立的统计学意义。
结论
在伴有多种相关心血管危险因素的糖尿病患者中，肌钙蛋白升高与慢性冠状动脉疾病的存在有关。肌钙蛋白可作为这一高危人群的生物标志物。
试验注册
http://www.controlled-trials.com
注册号
ISRCTN26970041。
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