Morton A R, Collier C P, Ali N, Dagnone L E
Department of Medicine, Queen's University, Kingston, Ontario, Canada.
ASAIO J. 1998 Sep-Oct;44(5):M433-5. doi: 10.1097/00002480-199809000-00021.
Current markers of myocardial injury lack specificity in patients with end-stage renal disease (ESRD). In particular, a false positive creatine kinase-MB (CKMB) elevation occurs in 5-10% of patients with ESRD. The aim of this study was to ascertain the relationship between CKMB and cardiac troponin I (cTnI), a new, highly sensitive and specific marker for myocardial injury, in the authors' dialysis population and compare their specificities. Blood samples were obtained from 112 dialysis patients (35 in peritoneal dialysis; 77 in hemodialysis). Patients were asymptomatic for cardiac ischemia and skeletal muscle injury. Mean +/- SD CKMB mass was 3.16 +/- 2.26 microg/L (range, 0.34-13.62), and cTnI was 0.025 +/- 0.061 ng/ml (range, 0.001-0.496). CKMB and cTnI levels did not correlate (r2 = 0.002; p = 0.61). CKMB mass concentration was significantly higher in men and in diabetics. No patient had a cTnI level greater than 1.5 microg/L, and eight asymptomatic patients had a CKMB mass greater than 6.7 microg/L. These data suggest a specificity of 100% for cTnI vs 94.6% for CKMB at these cutoff values. It is suggested that cTnI replace CKMB as a marker of myocardial injury in patients with ESRD.
终末期肾病（ESRD）患者中，目前的心肌损伤标志物缺乏特异性。特别是，5%-10%的ESRD患者会出现肌酸激酶同工酶（CKMB）假阳性升高。本研究的目的是确定在作者的透析人群中CKMB与心肌肌钙蛋白I（cTnI，一种用于心肌损伤的新型、高敏感性和特异性的标志物）之间的关系，并比较它们的特异性。从112例透析患者（35例腹膜透析；77例血液透析）中采集血样。患者无心脏缺血和骨骼肌损伤症状。CKMB质量的均值±标准差为3.16±2.26μg/L（范围为0.34-13.62），cTnI为0.025±0.061ng/ml（范围为0.001-0.496）。CKMB和cTnI水平无相关性（r2 = 0.002；p = 0.61）。男性和糖尿病患者的CKMB质量浓度显著更高。没有患者的cTnI水平大于1.5μg/L，8例无症状患者的CKMB质量大于6.7μg/L。这些数据表明，在这些临界值下，cTnI的特异性为100%，而CKMB为94.6%。建议在ESRD患者中，用cTnI取代CKMB作为心肌损伤的标志物。
