Significance of Acute versus Chronic Troponin T Elevation in Dialysis Patients
Significance of Acute versus Chronic Troponin T Elevation in Dialysis Patients
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透析患者急性肌钙蛋白 T 升高与慢性肌钙蛋白 T 升高的意义
DOI：
10.1159/000080679
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发表时间：
2004
影响因子：
--
通讯作者：
R. Zietse
中科院分区：
文献类型：
--
作者：
E. Ie;P. Klootwijk;W. Weimar;R. Zietse
引言：无急性冠脉综合征（ACS）的血液透析（HD）患者的心肌肌钙蛋白T（cTnT）通常升高。目的是评估无症状患者透析前cTnT对死亡率的预测价值。如果患者在随访期间出现症状，则随访cTnT以评估其对ACS的诊断价值。方法：纳入49例无症状HD患者：30例有心血管疾病史（CV+），19例无心血管疾病史（CV-）。11例患者在HD前和HD中测定cTnT、肌红蛋白和肌酸激酶（CK）。ACS期间，随访cTnT直至恢复。cTnT ≥ 0.03 µg/l视为升高。随访2年。结果：82%（40/49）患者cTnT升高。与CV-患者（12/19; p = 0.02）相比，CV+患者（28/30）的cTnT升高较多。血透期间cTnT、肌红蛋白和CK无明显变化。ACS期间，cTnT高于基线，恢复后趋于恢复至基线。死亡率为33%（16/49）。cTnT升高患者的死亡率（16/40）高于cTnT阴性患者（0/9; p = 0.02）。结论：无症状HD患者cTnT水平升高不是由急性心肌损伤或HD本身引起的。它们可能与慢性心肌损伤和清除率降低有关，并具有预后价值。然而，在ACS期间，cTnT升高高于个体基线可诊断急性心肌损伤。
Introduction: Cardiac troponin T (cTnT) is often elevated in hemodialysis (HD) patients without acute coronary syndrome (ACS). The aim was to assess the predictive value for mortality of pre-dialysis cTnT in asymptomatic patients. If patients became symptomatic during follow-up, cTnT was followed to assess its diagnostic value for ACS. Methods: Forty-nine asymptomatic HD patients were included: 30 patients with a history of cardiovascular disease (CV+) and 19 without (CV–). In 11 patients cTnT, myoglobin and creatine kinase (CK) were measured before and during HD. During ACS, cTnT was followed until recovery. A cTnT of ≧0.03 µg/l was considered elevated. Follow-up was 2 years. Results: cTnT was elevated in 82% (40/49). More CV+ patients had an elevated cTnT (28/30) than CV– patients (12/19; p = 0.02). There was no change in cTnT, myoglobin and CK during HD. During ACS, cTnT increased above baseline, and tended to return to baseline after recovery. Mortality was 33% (16/49). Patients with elevated cTnT had a higher mortality rate (16/40) than patients with negative cTnT (0/9; p = 0.02). Conclusions: Elevated cTnT levels in asymptomatic HD patients are not caused by acute myocardial injury or by HD itself. They may be related to chronic myocardial damage and decreased clearance, and are of prognostic value. During ACS, however, a cTnT rise above the individual baseline is diagnostic of acute myocardial injury.