Serum cardiac troponins and N-terminal pro-brain natriuretic peptide: A staging system for primary systemic amyloidosis
Serum cardiac troponins and N-terminal pro-brain natriuretic peptide: A staging system for primary systemic amyloidosis
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DOI：
10.1200/jco.2004.03.029
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发表时间：
2004-09-15
影响因子：
45.3
通讯作者：
Jaffe, AS
中科院分区：
文献类型：
--
作者：
Dispenzieri, A;Gertz, MA;Jaffe, AS
目的原发性系统性淀粉样变性（AL）是一种由潜在的比较引起的多系统疾病，AL浆细胞病变没有正式的分期系统。在研究和治疗中心之间很难。本研究小组先前发现血清心肌肌钙蛋白T （cTnT）升高是总生存期最有力的预测因子。其他报道称，n端脑利钠肽前体（NT-proBNP）是一个有价值的预后标志物。我们试图为AL患者建立一个分期系统。患者和方法：1979年4月至2000年11月期间在梅奥诊所就诊的242例新诊断的AL患者，就诊时有超声心动图和血清样本，符合本回顾性研究的条件。对242例cTnT和心肌肌钙蛋白I （cTnI）检测的患者进行NT-proBNP检测。使用NT-proBNP和cTnT或cTnI的阈值设计了两种预后模型（NT-proBNP < 332 ng/L, cTnT < 0.035 mug/L和cTnl < 0.1 mug/L）。根据NT-proBNP和肌钙蛋白水平是否都低，只有一个水平高，或两者都高，分别将患者分为I期，II期和III期。使用cTnT+NT-proBNP模型，33%、30%和37%的患者分别为I期、II期和III期，中位生存期分别为26.4、10.5和3.5个月。cTnI+NT-proBNP模型预测的中位生存期分别为27.2个月、11.1个月和4.1个月。结论将AL患者分为三个阶段是可能的，两个容易获得且可重复的试验为更一致和可靠的治疗结果交叉比较奠定了基础。(C) 2004年由美国临床肿瘤学会出版。
Purpose Primary systemic amyloidosis (AL) is a multisystemic disorder resulting from an underlying making comparisons There is no formal staging system for AL plasma cell dyscrasia,. between studies and treatment centers difficult. Our group previously identified elevated serum cardiac troponin T (cTnT) as the most powerful predictor of overall survival. Others have reported that N-terminal pro-brain natriuretic peptide (NT-proBNP) is a valuable prognostic marker. We sought to develop a staging system for patients with AL.Patients and Methods Two hundred forty-two patients with newly diagnosed AL who were seen at the Mayo Clinic between April 1979 and November 2000, and who had echocardiograms and stored serum samples at presentation were eligible for this retrospective review. NT-proBNP measurements were performed on 242 patients in whom cTnT and cardiac troponin I (cTnI) had been previously run. Two prognostic models were designed using threshold values of NT-proBNP and either cTnT or cTnI (NT-proBNP < 332 ng/L, cTnT < 0.035 mug/L, and cTnl < 0.1 mug/L). Depending on whether NT-proBNP and troponin levels were both low, were high for only one level, or were both high, patients were classified as stage I, II, or III, respectively.Results Using the cTnT+NT-proBNP model 33%, 30%, and 37% of patients were stages I, II, and III, respectively, with median survivals of 26.4, 10.5, and 3.5 months, respectively. The alternate cTnI+NT-proBNP model predicted median survivals of 27.2, 11.1, and 4.1 months, respectively.Conclusion Stratification of AL patients into three stages is possible with two readily available and reproducible tests setting the stage for more consistent and reliable cross comparisons of therapeutic outcomes. (C) 2004 by American Society of Clinical Oncology.