Department of Internal Medicine, Riverside Community Hospital, University of California, Riverside School of Medicine, Riverside, California, USA.
Division of Cardiology, University of California, Irvine School of Medicine, Irvine, California, USA.
Nephron. 2019;141(4):227-235. doi: 10.1159/000495946. Epub 2019 Feb 6.
Cardiovascular disease is prevalent in patients with chronic kidney disease (CKD) and responsible for approximately half of all CKD-related deaths. Unfortunately, the presence of CKD can lead to a challenging interpretation of cardiac biomarkers essential in accurate diagnosis and prompt management of heart failure and acute coronary syndrome. There is growing interest in novel cardiac biomarkers that may improve diagnostic accuracy reflecting myocardial injury, inflammation, and remodeling. Interpretation of these biomarkers in CKD can be complicated, since elevated levels may not reflect myocardial injury or wall tension but rather decreased urinary clearance with retention of solutes and/or overall CKD-associated chronic inflammation. In this review, we discuss the latest data on major and emerging cardiac biomarkers including B-type natriuretic peptide, troponin, suppression of tumorigenicity 2, growth and differentiation factor-15, galectin-3, and matrix gla protein, and their diagnostic and prognostic utility in the CKD population.
心血管疾病在慢性肾脏病（CKD）患者中很常见，约占所有 CKD 相关死亡人数的一半。不幸的是，CKD 的存在可能导致心脏生物标志物的解读变得具有挑战性，而心脏生物标志物对于心力衰竭和急性冠状动脉综合征的准确诊断和及时治疗至关重要。人们越来越关注新型心脏生物标志物，这些标志物可能会提高诊断准确性，反映心肌损伤、炎症和重构。在 CKD 中解读这些生物标志物可能会变得复杂，因为升高的水平可能并不反映心肌损伤或壁张力，而是由于溶质潴留和/或整体 CKD 相关的慢性炎症导致尿液清除率降低。在这篇综述中，我们讨论了主要和新兴的心脏生物标志物的最新数据，包括 B 型利钠肽、肌钙蛋白、肿瘤抑制因子 2、生长分化因子 15、半乳糖凝集素-3 和基质 Gla 蛋白，以及它们在 CKD 人群中的诊断和预后价值。
