Czyżewska Emilia, Ciepiela Olga
Department of Laboratory Medicine, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland.
J Clin Med. 2021 Oct 24;10(21):4903. doi: 10.3390/jcm10214903.
There is a possibility that renal dysfunction may potentially reduce the diagnostic power of the laboratory parameters Tn, NT-proBNP and sFLC levels, used in the current prognostic classification of AL amyloidosis and the diagnosis of heart involvement by amyloid. In this study, the impact of lowering the eGFR value on the usefulness of these parameters in the prognosis and diagnosis of the presence of amyloid in the myocardium was assessed in a group of 71 patients with newly diagnosed primary amyloidosis. The assessment of diagnostic power of laboratory parameters was performed on the entire study group, and in the ranges of eGFR ≥ 60 and < 60 mL/min/1.73 m. It has been proven that, with a decrease in the eGFR value, the concentrations of NT-proBNP and the κ uninvolved light chains increase significantly ( < 0.001). To assess the diagnostic power of laboratory parameters used in the diagnosis of myocardial involvement in patients with AL amyloidosis, an ROC analysis was performed. The highest values of AUC were obtained for the NT-proBNP concentration (AUC = 0.906). The lowest values of the AUC and Youden's index were obtained for the dFLC values (AUC = 0.723), and involved κ FLC concentration (AUC = 0.613). For all compared parameters, the smallest values of the AUC were obtained for eGFR (<60 mL/min/1.73 m). It seems that the most suitable cardiac parameter used in the prognostic classification of AL amyloidosis, independent of renal function, is TnI. It should be noted that a concentration of involved λ chains hada higher diagnostic power to assess the heart involvement, compared to the routinely used "cardiac parameters", TnI and NT-proBNP. It can therefore be an additional parameter used to assess the presence of amyloid in the myocardium. A decrease in eGFR value influenced the change in the diagnostic cut-off points of the most analyzed laboratory parameters. Finally, it is concluded that lowering the eGFR value reduces the utility of laboratory parameters used in the prognostic classification of AL amyloidosis.
肾功能不全有可能会降低实验室参数肌钙蛋白（Tn）、N末端B型利钠肽原（NT-proBNP）和血清游离轻链（sFLC）水平的诊断效能，这些参数目前用于AL淀粉样变性的预后分类以及淀粉样蛋白所致心脏受累的诊断。在本研究中，对71例新诊断的原发性淀粉样变性患者组成的队列，评估降低估算肾小球滤过率（eGFR）值对这些参数在心肌淀粉样变性预后及诊断中的效用的影响。对整个研究组以及eGFR≥60和<60 mL/min/1.73 m范围的患者进行实验室参数诊断效能的评估。已证实，随着eGFR值降低，NT-proBNP和κ非受累轻链的浓度显著增加（<0.001）。为评估用于诊断AL淀粉样变性患者心肌受累的实验室参数的诊断效能，进行了ROC分析。NT-proBNP浓度获得的曲线下面积（AUC）最高值（AUC = 0.906）。dFLC值（AUC = 0.723）和受累κ轻链浓度（AUC = 0.613）获得的AUC和尤登指数最低值。对于所有比较的参数，eGFR（<60 mL/min/1.73 m）获得的AUC最小值。似乎在AL淀粉样变性的预后分类中，独立于肾功能的最合适的心脏参数是肌钙蛋白I（TnI）。应当指出，与常规使用的“心脏参数”TnI和NT-proBNP相比，受累λ链浓度在评估心脏受累方面具有更高的诊断效能。因此，它可以作为评估心肌淀粉样变性存在的一个额外参数。eGFR值降低影响了大多数分析的实验室参数诊断界值的变化。最后得出结论，降低eGFR值会降低用于AL淀粉样变性预后分类的实验室参数的效用。
