Division of Nephrology, Kidney Research Laboratory, West China Biostatistics and Cost Benefit Analysis Center of West China Hospital, West China Medical School, Sichuan University, Chengdu, China.
Division of Thyroid Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, China.
Sci Rep. 2017 Feb 1;7:41350. doi: 10.1038/srep41350.
High-sensitive cardiac troponin T (hs-TnT) is a critical biomarker in diagnosis of acute myocardial infarction (AMI). However, CKD individuals usually have elevated hs-TnT even in the absence of AMI. Our study aimed to explore the optimal cutoff-value of hs-TnT and further to improve diagnostic accuracy of AMI in CKD patients. Clinical data of 489 patients were collected from the maintained database between September 2010 and June 2014. CKD patients with AMI were assigned to CKD+AMI group and CKD patients without AMI were assigned to CKD group. Receiver operating characteristic curves were utilized to derive the optimal cutoff-value. In CKD+STEMI and CKD group, hs-TnT was increased with descending eGFR. In CKD+NSTEMI group, hs-TnT showed an upward trend with increasing SYNTAX Score. In patients with CKD+STEMI, hs-TnT was significantly correlated with SYNTAX Score in CKD stage 2, stage 4 and in total. In CKD patients, the optimal cutoff-value of hs-TnT for diagnosis of AMI was 129.45 ng/l with 75.2% sensitivity and 83.2% specificity. The cutoff-value appeared to be hs-TnT level of 99.55ng/l in CKD stage 3, 129.45 ng/l in CKD stage 4, 105.50 ng/l in CKD stage 5 and 149.35 ng/l in dialysis patients, respectively. In different stages of CKD, eGFR-range-specific optimal cutoff-values should be considered.
高敏心肌肌钙蛋白 T（hs-TnT）是诊断急性心肌梗死（AMI）的关键生物标志物。然而，即使在没有 AMI 的情况下，CKD 患者的 hs-TnT 通常也会升高。我们的研究旨在探讨 hs-TnT 的最佳截断值，并进一步提高 CKD 患者 AMI 的诊断准确性。
从 2010 年 9 月至 2014 年 6 月，从维护的数据库中收集了 489 例患者的临床数据。将 AMI 的 CKD 患者分配到 CKD+AMI 组，无 AMI 的 CKD 患者分配到 CKD 组。利用受试者工作特征曲线得出最佳截断值。在 CKD+STEMI 和 CKD 组中，hs-TnT 随着 eGFR 的降低而增加。在 CKD+NSTEMI 组中，hs-TnT 随着 SYNTAX 评分的增加呈上升趋势。在 CKD+STEMI 患者中，hs-TnT 与 CKD 2 期、4 期和总期的 SYNTAX 评分显著相关。在 CKD 患者中，hs-TnT 诊断 AMI 的最佳截断值为 129.45ng/l，灵敏度为 75.2%，特异性为 83.2%。在 CKD 3 期，hs-TnT 水平为 99.55ng/l，CKD 4 期为 129.45ng/l，CKD 5 期为 105.50ng/l，透析患者为 149.35ng/l。在 CKD 的不同阶段，应考虑 eGFR 范围特异性最佳截断值。
