高敏肌钙蛋白T检测在诊断有无肾功能不全患者急性心肌梗死中的价值。

Value of the high-sensitivity troponin T assay for diagnosis of acute myocardial infarction in patients with and without renal insufficiency.

作者信息

Hsu Cheng-Kai, Wu I-Wen, Chen Yih-Ting, Peng Chia-Huei, Tseng Yi-Ju, Chen Yung-Chang, Hung Ming-Jui, Kao Yu-Cheng

机构信息

Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan.

College of Medicine, Chang Gung University, Taoyuan, Taiwan.

出版信息

Ren Fail. 2020 Nov;42(1):1142-1151. doi: 10.1080/0886022X.2020.1845732.

DOI:10.1080/0886022X.2020.1845732

PMID:33183098

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7671591/

Abstract

BACKGROUND

Cardiac troponins are important markers for diagnosis of acute myocardial infarction (AMI) in general population; however, chronically-elevated troponins levels are often seen in patients with renal insufficiency, which reduce their diagnostic accuracy. The aim of our study was to access the diagnostic values of initial high-sensitive cardiac troponin T (hs-cTnT) and relative change of hs-cTnT for AMI in patients with and without renal insufficiency.

METHODS

Cardiac care unit patients with elevated hs-cTnT levels in 2017-2018 were enrolled. Receiver operating characteristic (ROC) curves were used to evaluate initial hs-cTnT levels and relative changes after 3 h of enrollment for diagnosis of AMI in patients with estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m (low), and eGFR ≥ 60 mL/min/1.73 m (normal).

RESULTS

Of 359 patients, 240 patients had low eGFR, and 119 patients had normal eGFR. The area under the ROC curve (AUC) for the initial hs-cTnT levels was 0.58 (95% CI, 0.5-0.65, = 0.053) among patients with low eGFR and 0.54 (95% CI, 0.4-0.67, = 0.612) among patients with normal eGFR. AUCs for relative changes of hs-cTnT were 0.82 (95% CI, 0.76-0.88, < 0.001) in patients with low eGFR and 0.82 (95% CI, 0.71-0.91, < 0.001) in patients with normal eGFR. Optimal cutoff values for the relative changes in hs-cTnT were 16% and 12% in patients with low eGFR and normal eGFR, respectively.

CONCLUSIONS

Relative changes in hs-cTnT levels had better diagnostic accuracy than initial hs-cTnT levels.

摘要

背景

心肌肌钙蛋白是一般人群急性心肌梗死（AMI）诊断的重要标志物；然而，肾功能不全患者常出现肌钙蛋白水平长期升高的情况，这降低了其诊断准确性。我们研究的目的是评估初始高敏心肌肌钙蛋白T（hs-cTnT）及其相对变化对有无肾功能不全患者AMI的诊断价值。

方法

纳入2017 - 2018年hs-cTnT水平升高的心脏监护病房患者。采用受试者工作特征（ROC）曲线评估估算肾小球滤过率（eGFR）<60 mL/min/1.73 m²（低）和eGFR≥60 mL/min/1.73 m²（正常）患者入院时初始hs-cTnT水平及入院3小时后相对变化对AMI的诊断价值。

结果

359例患者中，240例患者eGFR低，119例患者eGFR正常。eGFR低的患者中，初始hs-cTnT水平的ROC曲线下面积（AUC）为0.58（95%CI，0.5 - 0.65，P = 0.053），eGFR正常的患者中为0.54（95%CI，0.4 - 0.67，P = 0.612）。hs-cTnT相对变化的AUC在eGFR低的患者中为0.82（95%CI，0.76 - 0.88，P < 0.001），在eGFR正常的患者中为0.82（95%CI，0.71 - 0.91，P < 0.001）。hs-cTnT相对变化的最佳截断值在eGFR低和正常的患者中分别为16%和12%。