心肌损伤标记物对慢性肾脏病非透析患者评估心脏结构功能的预测

蒋红樱; 窦丽娜; 廖云娟; 曾怡; 白彝华; 杨敏

心肌损伤标记物对慢性肾脏病非透析患者评估心脏结构功能的预测

昆明医科大学第二附属医院肾内科

基金项目:

基金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目 (2015FB054); 云南省教育厅科学研究基金资助项目 (2015C031Y);

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出版历程
- 收稿日期: 2017-05-11

Clinical Value of Myocardial Injury Markers in Evaluating Cardiac Structure and Function of Chronic Kidney Disease Patients without Dialysis

Funds:

基金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目 (2015FB054); 云南省教育厅科学研究基金资助项目 (2015C031Y);

摘要

摘要: 目的探讨心肌损伤标记物血浆高敏心肌肌钙蛋白T (hs-c Tn T) 、N末端B型利钠肽原 (NT-pro BNP) 、肌酸激酶同工酶 (CK-MB) 的水平对不同时期的慢性肾脏病 (CKD) 非透析患者的预测价值.方法选取CKD非透析患者共137例, 检测心肌损伤标记物, 做超声心动图等检查, 由ROC曲线下面积评价诊断价值.结果血浆hs-c Tn T、NT-pro BNP、CK-MB在CKD5期组最高, CKD3-4期组高于CKD1-2期组.左心室肥厚 (LVH) 和左室舒张功能不全 (E/A<1) 在CKD5期组和CKD3-4期组低于CKD1-2期组.有LVH和E/A<1患者hs-c Tn T、NT-pro BNP、CK-MB水平显著高于无LVH和E/A<1患者.用ROC曲线分析CKD患者心肌损伤标记物对LVH和E/A<1评估, 敏感性和特异性最高是CK-MB, 其次NT-pro BNP, hs-c Tn T, P<0.001.结论 CKD非透析患者心肌损伤标记物水平随着肾功能恶化而进行性升高, 且与心脏结构功能密切相关, CK-MB在诊断LVH和E/A<1的准确性最高.
- 慢性肾脏病 /
- 高敏心肌肌钙T /
- N末端B型利钠肽原 /
- 肌酸激酶同工酶 /
- 超声心动图
Abstract: Objective To study the changes of myocardial injury markers hs-c Tn T, NT-pro BNP and CK-MB levels in CKD patients without dialysis in different stags and their value for outcome prediction. Methods A total of 137 cases of non-dialysis patients with chronic kidney disease were enrolled in this cross-sectional study.The myocardial injury markers hs-c Tn T, NT-pro BNP, CK-MBH and cardiac ultrasonography were examined. And the area under ROC was measured and compared to evaluate the value of different biomarkers in predicting cardiac dysfunction and outcome. Results The levels of plasma hs-c Tn T, NT-pro BNP and CK-MB in CKD5 group were the highest in the three groups, and the biomarlers in CKD3-4 group was significantly higher than CKD1-2 group (P<0.001) . The expression of LVH and the E/A <1, LVH in CKD5 group and CKD3-4 group were lower than CKD1-2 (P<0.001) .The levels of plasma hs-c Tn T, NT-pro BNP and CK-MB in the patients with CKD were measured and the left ventricular hypertrophy was evaluated by the curve of the working curve of the subjects.Through the ROC curve, the CK-MB had the highest accuracy of left ventricular hypertrophy, followed by NT-pro BNP and hs-c Tn T. Conlusions Levels of hs-c Tn T, NT-pro BNP and CK-MB are elevated in patients with CKD. CK-MB is a good biomarker in predicting cardic dysfunction of CKD patients with early cardiovascular disease.
- Chronic kidney disease /
- hs-cTnT /
- NT-proBNP /
- CK-MB /
- Echocardiography

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参考文献(22)

[1]	[1] ZHANG L, WANG F, WANGL, et al.Prevalence of chronic kidney disease in China:a cross-sectional survey[J].Lancet, 2012, 379 (9818) :815-822.
[2]	[2]O'SEAGHDHA C M, LYASS A, MASSARO J M, et al.Chronic Kidney Disease in the General Population[J].Circulation, 2017, 116 (1) :85-97.
[3]	[3]DEVEREUX R B, REICHEK N.Echocardiographic determination of left ventncular mass in man:Anatomic validation of the method[J].Circulation, 1977, 55 (4) :613-618.
[4]	[4]IWASHIMA Y, HORIO T, KURODA S, et al.Influence of plasma aldosterone on left ventricular geometry and diastolic function in treated essential hypertension[J].Hypertens Res, 2002, 25 (1) :49-56.
[5]白彝华, 潘毅, 蒋红樱, 等.云南地区腹膜透析患者发生心脑血管事件的危险因素分析[J].昆明医科大学学报, 2016, 37 (4) :95-98.
[6]	[6]MISHRA R K, LI Y, DEFILIPPI C, et al.Association of cardiac troponin T with left ventricular structure and function in CKD[J].American Journal of Kidney Diseases, 2013, 61 (5) :701-709.
[7]刘巨鹏, 李建权, 白萍, 等.陈旧心肌梗死患者胱抑素C水平及预后相关性研究[J].昆明医科大学学报, 2015, 36 (9) :118-121.
[8]	[8]OKURA H, SUZUKI R, SUGIBAYASHI S, et al.Performance and clinical utility of a high-sensitivity troponin T assay[J].Rinsho Byori the Japanese Journal of Clinical Pathology, 2012, 60 (5) :407-13.
[9]谢瑜, 罗惠民, 江勇, 等.慢性肾脏病患者腺苷负荷心肌灌注显像及肌钙蛋白水平的临床分析[J].昆明医科大学学报, 2015, 36 (6) :71-76.
[10]肖文凯, 叶平.慢性肾脏病患者血清高敏肌钙蛋白T水平变化及意义[J].中华老年心脑血管病杂志, 2015, 17 (5) :546-548.
[11]	[11]KHAN I A, FINK J, NASS C, et al.N-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide for identifying coronary artery disease and left ventricular hypertrophy in ambulatory chronic kidney disease patients[J].American Journal of Cardiology, 2006, 97 (10) :1530-1534.
[12]李艳锋, 李俊, 黄波.血液透析治疗对尿毒症患者BNP水平的影响[J].昆明医科大学学报, 2015, 36 (12) :91-93.
[13]周杨, 王瑞娟, 吕颖, 等.血NT-Pro BNP对CKD非透析患者有效循环血容量评价的研究[J].中国中西医结合肾病杂志, 2016, 17 (4) :335-337.
[14]郑永仁, 王礡, 郑红, 等.滇西亚种树鼩心肌酶、部分肾功能指标的测定及其初步分析[J].昆明医科大学学报, 2013, 34 (10) :5-9.
[15]	[15]FLORESLM, HERNNDEZDOMINGUEZJL, OTERO A, et al.Cardiac troponin I determination in patients with chronic renal failure[J].Nefrologia Publicacion Oficial De La Sociedad Espanola Nefrologia, 2006, 26 (1) :107.
[16]	[16]DESAI A S, TOTO R, JAROLIM P, et al.Association between cardiac biomarkers and the development of ESRD in patients with type 2 diabetes mellitus, anemia, and CKD[J].American Journal of Kidney Diseases, 2011, 58 (5) :717.
[17]	[17]DUBIN R F, BEATTY A L, TEERLINK J R, et al.Associations of tissue doppler imaging with NT-pro BNP and hs-Tn T:A pilot study in end-stage renal Disease[J].Echocardiography, 2014, 31 (10) :1205-12.
[18]武晓春, 方奕.119例合并高血压的中重度慢性肾脏病患者心脏彩超评价心脏结构和功能的临床研究[J].中国中西医结合肾病杂志, 2013, 14 (10) :886-889.
[19]叶学群, 聂磊.超声心动图结合动态心电图诊断冠心病合并心力衰竭的价值[J].昆明医科大学学报, 2017, 38 (2) :95-98.
[20]	[20]LEVIN A, THOMPSON C R, ETHIER J, et al.Left ventricular mass index increase in early renal disease:impact of decline in hemoglobin[J].American Journal of Kidney Diseases, 1999, 34 (1) :125.
[21]庞明杰, 张宏, 范洁, 等.NT-pro BNP对ST段抬高的急性心梗患者急诊PCI术后临床结果的预测价值[J].昆明医科大学学报, 2013, 34 (4) :98-102.
[22]	[22]DUBIN R F, LI Y, HE J, et al.Predictors of high sensitivity cardiac troponin T in chronic kidney disease patients:a cross-sectional study in the chronic renal insufficiency cohort (CRIC) [J].BMC Nephrology, 2013, 14 (1) :229.

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