Kampmann Jan, Heaf James, Backer Mogensen Christian, Pedersen Andreas Kristian, Granhøj Jeff, Mickley Hans, Brandt Frans
Internal Medicine Research Unit, University Hospital of Southern Denmark, Sydvang 1, 6400 Sonderborg, Denmark.
Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark.
Diagnostics (Basel). 2022 Jan 21;12(2):276. doi: 10.3390/diagnostics12020276.
Identifying acute myocardial infarction in patients with renal disease is notoriously difficult, due to atypical presentation and chronically elevated troponin. The aim of this study was to identify a specific troponin T/troponin I cut-off value for diagnosis of acute myocardial infarction in patients with renal impairment via meta-analysis. Two investigators screened 2590 publications from MEDLINE, Embase, PubMed, Web of Science, and the Cochrane library. Only studies that investigated alternative cut-offs according to renal impairment were included. Fifteen articles fulfilled the inclusion criteria. Six studies were combined for meta-analysis. The manufacturer's upper reference level for troponin T is 14 ng/L. Based on the meta-analyses, cut-off values for troponin in patients with renal impairment with myocardial infarction was 42 ng/L for troponin I and 48 ng/L for troponin T. For patients on dialysis the troponin T cut-off is even higher at 239 ng/L. A troponin I cut-off value for dialysis patients could not be established due to lack of data. The 15 studies analyzed showed considerable diversity in study design, study population, and the definition of myocardial infarction. Further studies are needed to define a reliable troponin cut-off value for patients with kidney disease, especially in dialysis patients, and to allow necessary subanalysis.
由于临床表现不典型以及肌钙蛋白长期升高，在肾病患者中识别急性心肌梗死 notoriously difficult。本研究的目的是通过荟萃分析确定用于诊断肾功能损害患者急性心肌梗死的特定肌钙蛋白T/肌钙蛋白I临界值。两名研究人员从MEDLINE、Embase、PubMed、Web of Science和Cochrane图书馆筛选了2590篇出版物。仅纳入了根据肾功能损害研究替代临界值的研究。15篇文章符合纳入标准。6项研究被合并进行荟萃分析。肌钙蛋白T的制造商参考上限为14 ng/L。基于荟萃分析，肾功能损害合并心肌梗死患者的肌钙蛋白I临界值为42 ng/L，肌钙蛋白T为48 ng/L。对于透析患者，肌钙蛋白T临界值更高，为239 ng/L。由于缺乏数据，无法确定透析患者的肌钙蛋白I临界值。所分析的15项研究在研究设计、研究人群和心肌梗死定义方面存在相当大的差异。需要进一步研究来确定肾病患者，尤其是透析患者可靠的肌钙蛋白临界值，并进行必要的亚组分析。
