Chen Michael, Gerson Howard, Eintracht Shaun, Nessim Sharon J, MacNamara Elizabeth
Department of Diagnostic Medicine, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada.
Department of Diagnostic Medicine, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada.
Am J Cardiol. 2017 Dec 1;120(11):2061-2064. doi: 10.1016/j.amjcard.2017.08.026. Epub 2017 Sep 4.
Cardiac troponin (cTn) is essential for the diagnosis of an acute coronary syndrome (ACS). However, in end-stage renal disease (ESRD) baseline cTn levels are often elevated, and it is unknown whether the hemodialysis (HD) procedure affects cTn levels. This leaves clinicians unsure of how to interpret cTn in HD patients with cardiac ischemia. We therefore sought to determine if plasma levels of high-sensitivity cardiac troponin T (hs-cTnT) vary during or after HD treatment. We prospectively enrolled 10 chronic HD patients who were admitted to our institution. All participants were receiving thrice weekly HD before admission and were medically stable. Those admitted for ACS or to critical care units were excluded. Baseline hs-cTnT was measured immediately before HD. For the subsequent 6 hours, hs-cTnT was measured every 2 hours and every 3 hours thereafter for a total collection period of 24 hours. A significant decline in mean hs-cTnT was noted with HD. During HD (2 hours after HD initiation), hs-cTnT decreased by 10.7% (confidence interval 5% to 17%). Immediately after HD (4 hours after HD initiation), a decline of 12% (confidence interval 5% to 19%) was observed. Thereafter hs-cTnT began to rise. Hs-cTnT levels returned to baseline by 11 hours after HD completion and remained stable for the reminder of the study. In conclusion, HD induces a short-lived negative bias in hs-cTnT. When measured for investigation of ACS, hs-cTnT concentration should be interpreted with respect to time of dialysis and specimen collection.
心肌肌钙蛋白（cTn）对于急性冠状动脉综合征（ACS）的诊断至关重要。然而，在终末期肾病（ESRD）中，基线cTn水平常常升高，并且血液透析（HD）程序是否会影响cTn水平尚不清楚。这使得临床医生在解释患有心脏缺血的HD患者的cTn时感到困惑。因此，我们试图确定高敏心肌肌钙蛋白T（hs-cTnT）的血浆水平在HD治疗期间或之后是否会发生变化。我们前瞻性地纳入了10名入住我们机构的慢性HD患者。所有参与者在入院前每周接受三次HD治疗，且病情稳定。因ACS入院或入住重症监护病房的患者被排除在外。在HD治疗前立即测量基线hs-cTnT。在随后的6小时内，每2小时测量一次hs-cTnT，此后每3小时测量一次，总共采集24小时。观察到HD治疗后平均hs-cTnT显著下降。在HD治疗期间（HD开始后2小时），hs-cTnT下降了10.7%（置信区间5%至17%）。HD治疗后立即（HD开始后4小时），观察到下降了12%（置信区间5%至19%）。此后hs-cTnT开始上升。HD治疗完成后11小时，hs-cTnT水平恢复到基线，并在研究的剩余时间内保持稳定。总之，HD在hs-cTnT上诱导了短暂的负偏差。在检测ACS时进行测量时，应根据透析时间和标本采集时间来解释hs-cTnT浓度。
