在晚期慢性肾脏病中，最大应激能力与肌钙蛋白 T 和腹主动脉钙化评分的相关性。
Association of maximal stress ergometry performance with troponin T and abdominal aortic calcification score in advanced chronic kidney disease.
机构信息
Kidney Centre, Turku University Hospital and University of Turku, Turku, Finland.
Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital and University of Turku, Turku, Finland.
出版信息
BMC Nephrol. 2021 Feb 4;22(1):50. doi: 10.1186/s12882-021-02251-y.
BACKGROUND
Cardiac biomarkers Troponin T (TnT) and N-terminal pro-B-type natriuretic peptide (proBNP) and abdominal aortic calcification score (AAC) are associated with cardiovascular events and mortality in patients with chronic kidney disease (CKD). The effects of cardiac biomarkers and AAC on maximal exercise capacity in CKD are unknown and were studied.
METHODS
One hundred seventy-four CKD 4-5 patients not on maintenance dialysis underwent maximal bicycle ergometry stress testing, lateral lumbar radiograph to study AAC, echocardiography and biochemical assessments.
RESULTS
The subjects with proportional maximal ergometry workload (WMAX%) less than 50% of the expected values had higher TnT, proBNP, AAC, left ventricular end-diastolic diameter, left ventricular mass index, E/e' and pulse pressure, and lower global longitudinal strain compared to the better performing patients. TnT (β = - 0.09, p = 0.02), AAC (β = - 1.67, p < 0.0001) and diabetes (β = - 11.7, p < 0.0001) remained significantly associated with WMAX% in the multivariable model. Maximal ergometry workload (in Watts) was similarly associated with TnT and AAC in addition to age, male gender, hemoglobin and diastolic blood pressure in a respective multivariate model. AAC and TnT showed fair predictive power for WMAX% less than 50% of the expected value with AUCs of 0.70 and 0.75, respectively.
CONCLUSIONS
TnT and AAC are independently associated with maximal ergometry stress test workload in patients with advanced CKD.
TRIAL REGISTRATION
http://www.ClinicalTrials.gov NCT04223726.
背景
心肌生物标志物肌钙蛋白 T（TnT）和 N 末端脑利钠肽前体（proBNP）以及腹主动脉钙化评分（AAC）与慢性肾脏病（CKD）患者的心血管事件和死亡率相关。心脏生物标志物和 AAC 对 CKD 患者最大运动能力的影响尚不清楚，本研究对此进行了探讨。
方法
174 名未接受维持性透析的 CKD 4-5 期患者接受了最大自行车测功仪运动测试、侧位腰椎 X 光片以研究 AAC、超声心动图和生化评估。
结果
与表现较好的患者相比，比例最大做功量（WMAX%）低于预期值 50%的患者的 TnT、proBNP、AAC、左心室舒张末期直径、左心室质量指数、E/e'和脉压更高，而整体纵向应变更低。在多变量模型中，TnT（β=−0.09，p=0.02）、AAC（β=−1.67，p<0.0001）和糖尿病（β=−11.7，p<0.0001）与 WMAX%仍呈显著相关。在多变量模型中，最大做功量（以瓦特为单位）与 TnT 和 AAC 相似，还与年龄、性别、血红蛋白和舒张压相关。AAC 和 TnT 对 WMAX%低于预期值 50%的预测能力相当，AUC 分别为 0.70 和 0.75。
结论
TnT 和 AAC 与 CKD 晚期患者的最大测功仪应激试验工作量独立相关。
试验注册
http://www.ClinicalTrials.gov NCT04223726。
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