Serum troponin T measurement in patients with chronic renal impairment predicts survival and vascular disease: a 2 year prospective study.
Serum troponin T measurement in patients with chronic renal impairment predicts survival and vascular disease: a 2 year prospective study.
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慢性肾功能不全患者的血清肌钙蛋白 T 测量可预测生存率和血管疾病：一项为期 2 年的前瞻性研究。
DOI：
10.1093/ndt/gfg198
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
P. Ackrill
中科院分区：
文献类型：
--
作者：
G. Wood;B. Keevil;J. Gupta;R. Foley;A. Bubtana;G. McDowell;P. Ackrill
背景
终末期肾功能衰竭患者的心血管死亡率较高，对这些患者进行早期风险分层可能有助于临床管理，改善结局。心肌肌钙蛋白T（cTnT）是心肌细胞的一种成分，在心肌坏死后释放到循环中。它已被证明是不稳定型心绞痛患者的预后意义。cTnT在肾脏疾病患者中的作用尚不清楚。因此，本研究的目的是评估cTnT在慢性肾损害患者透析前的预后意义。
方法
96例慢性肾功能不全患者在定量实验室方法测定cTnT后进行前瞻性随访。确定2年后的临床结果。cTnT测定值与生化指标及临床终点相关。
结果
在评估cTnT的预后意义时使用0.1 ng/ml的截止值。25例患者cTnT >0.1 ng/ml，71例患者cTnT ≤ 0.1 ng/ml。21例患者在随访期间死亡。其中11例患者在进入研究时cTnT升高。cTnT >0.1 ng/ml的患者死亡率为42%，低于临界值的患者死亡率为14%。33例患者死亡或发生血管事件。高水平组的死亡率或血管事件发生率为64%，而低于临界值组的死亡率或血管事件发生率为24%。研究结束时，23例患者接受持续性非卧床腹膜透析治疗，29例接受血液透析治疗，22例接受功能性肾移植，1例患者未接受肾脏替代治疗。发现显著影响cTnT的因素是糖尿病、年龄和尿素。cTnT是这些患者生存的重要预测因子。cTnT值高的患者更有可能最终接受血液透析。cTnT水平与肾功能无相关性。
结论
这些结果表明，在肾损害患者中，在开始肾脏替代治疗前测量cTnT是生存率的重要独立预测因素。cTnT确实显示出作为一种预后检测的潜力，可对心血管高风险患者进行分层，并可在该患者组中进行强化风险因素调整。这对肾移植患者的选择有一定的指导意义。
BACKGROUND
Cardiovascular mortality in end-stage renal failure patients is high and early risk stratification in these patients may aid clinical management improving outcomes. Cardiac troponin T (cTnT) is a component of the cardiac myocyte which is released into the circulation following myocardial necrosis. It has been shown to be of prognostic significance in patients with unstable angina. The role of cTnT in patients with renal disease remains unclear. The aim of this investigation, therefore, was to assess the prognostic significance of cTnT in chronic renal impairment patients, pre-dialysis.
METHODS
Ninety-six patients with chronic renal impairment were followed prospectively after cTnT determination by a quantitative laboratory method. The clinical outcomes after 2 years were determined. The measured cTnT values were correlated with biochemical parameters and clinical end-points.
RESULTS
A cut-off of 0.1 ng/ml was used in assessing the prognostic significance of cTnT. Twenty-five patients had a cTnT >0.1 ng/ml, whilst 71 had a cTnT <or=0.1 ng/ml. Twenty-one patients died during the follow-up period. Eleven of these had elevated cTnT at entry into the study. Death rate in the patients with cTnT >0.1 ng/ml was 42% compared with 14% in those with levels below the cut-off. Thirty-three patients died or had a vascular event. The rate of death or a vascular event in the elevated group was 64% compared with 24% in those with levels below the cut-off. At the end of the study, 23 patients were treated by continuous ambulatory peritoneal dialysis, 29 by haemodialysis, 22 had functioning renal transplants and one patient was not on renal replacement therapy. Factors that were found to significantly affect cTnT were diabetes, age and urea. cTnT was found to be a significant predictor of survival in these patients. Patients with high cTnT values were more likely to end up on haemodialysis. No relation of renal function to cTnT level was found.
CONCLUSIONS
These results show that in patients with renal impairment, the measurement of cTnT prior to commencing renal replacement is a significant independent predictor of survival. cTnT did show potential as a prognostic test to stratify patients with a high cardiovascular risk and may enable intensive risk factor modification in this patient group. This may be of further use in selection of patients' suitability for renal transplantation.