Service of Nephrology, HFR Hôpital cantonal, Fribourg, Switzerland.
HFR Laboratory, HFR Hôpital cantonal, Fribourg, Switzerland.
Hemodial Int. 2022 Apr;26(2):166-175. doi: 10.1111/hdi.12985. Epub 2021 Dec 13.
Cardiology guidelines recommend measuring high-sensitivity cardiac troponin (hs-cTn) for the diagnostic work-up of acute coronary syndromes (ACS). Many hospitals measure hs-cTnT, but preliminary data have shown that hs-cTnT is higher than normal in many hemodialysis patients without evidence of ACS. The purpose of this study was therefore to determine the hs-cTnT levels every month for 1 year in asymptomatic hemodialysis patients, in order to assess their changes over time relative to creatine kinase.
Fourty-four hemodialysis patients (mean age 67 ± 14 years) were included. The predialysis levels of fifth-generation hs-cTnT, CK, and CK-MB were measured every month for 1 year using a Cobas® 6000 analyzer (Roche Diagnostics, Switzerland).
Almost 100% of hs-cTnT measurements were higher than normal (N < 14 ng/L); the mean ± SD annual level was 84 ± 59 ng/L, ranging from a minimum of 24 ± 2 to 241 ± 28 ng/L in individual patients. The mean levels of CK and CK-MB were normal. Thirteen myocardial infarctions were analyzed, which were all associated with an initial elevation in hs-cTnT >45% from the individual baseline value. By comparison, CK and CK-MB only increased in 38% and 31% of these myocardial infarctions, respectively.
hs-cTnT is persistently higher than normal in chronic hemodialysis patients. Standard algorithms for diagnosing ACS can obviously not be used and alternative diagnostic strategies need to be developed. According to our data, and given the huge variation in baseline hs-cTnT levels among patients, the use of higher cut-offs as proposed in the literature cannot be recommended. Instead, we consider that hs-cTnT should be checked at regular intervals (e.g., every 3-6 months) in order to establish individual baseline levels for hs-cTnT. This approach, in most instances, not only makes it possible to more rapidly rule-in but also to rapidly rule-out, cases of ACS in hemodialysis patients who develop cardiac symptoms.
心脏病学指南建议使用高敏心肌肌钙蛋白（hs-cTn）对急性冠状动脉综合征（ACS）进行诊断性检查。许多医院都测量 hs-cTnT，但初步数据表明，许多没有 ACS 证据的血液透析患者的 hs-cTnT 水平高于正常。因此，本研究的目的是在无症状血液透析患者中每月测量 hs-cTnT 水平，为期 1 年，以评估其随时间的变化与肌酸激酶的关系。
纳入 44 名血液透析患者（平均年龄 67 ± 14 岁）。使用 Cobas® 6000 分析仪（罗氏诊断公司，瑞士），每月测量一次第 5 代 hs-cTnT、CK 和 CK-MB 的预透析水平，为期 1 年。
几乎 100%的 hs-cTnT 测量值高于正常水平（N < 14 ng/L）；平均年度水平为 84 ± 59 ng/L，个体患者的范围从最低的 24 ± 2 到 241 ± 28 ng/L。CK 和 CK-MB 的平均水平正常。分析了 13 例心肌梗死，均与初始 hs-cTnT 水平升高>45%相关，超过个体基线值。相比之下，CK 和 CK-MB 仅分别在 38%和 31%的心肌梗死中升高。
hs-cTnT 在慢性血液透析患者中持续高于正常水平。用于诊断 ACS 的标准算法显然不能使用，需要开发替代的诊断策略。根据我们的数据，以及患者之间 hs-cTnT 基线水平的巨大差异，不能推荐文献中提出的更高的截断值。相反，我们认为应该定期检查 hs-cTnT（例如，每 3-6 个月），以确定 hs-cTnT 的个体基线水平。这种方法在大多数情况下不仅可以更快地确定 ACS 的诊断，还可以更快地排除血液透析患者出现心脏症状时 ACS 的发生。
