血清心肌肌钙蛋白T对维持性血液透析患者心血管事件和血液透析充分性的评价价值

Value of serum cardiac troponin T on predicting cardiovascular event and evaluating hemodialysis adequacy in maintainence hemodialysis patients

目的 探讨将血清心肌肌钙蛋白T（cTnT）列入维持性血液透析患者心血管事件和透析充分性评价体系的临床价值和意义.方法 将47例慢性肾衰竭并规律性进行维持性血液透析患者分为A组（25例）和B组（22例）,A组给予普通血液透析（HD）4 h×3次/周,B组给予普通HD4 h×2次/周＋高通量血液透析滤过（HDF）4 h×1次/周.于治疗前及治疗后每3个月检测1次血生化指标、cTnT和心脏彩超.观测终点为患者死亡或发生心血管事件或到研究截止日期.结果 B组于治疗第3个月开始血清cTnT水平较A组明显下降,并一直保持显著低于A组水平;A组于治疗第3个月开始二尖瓣口血流舒张早期流速与舒张晚期流速比值（E/A）逐渐减低,而B组维持相对恒定,到第18个月时,A组E/A开始显著低于B组;A组于治疗第3个月开始左心室射血分数（LVEF）逐渐减低,而B组维持相对恒定,到第12个月时,A组LVEF开始显著低于B组.治疗第12个月时,完成随访的42例患者血清cTnT与E/A和LVEF均呈显著正相关（r值分别为0.54和0.66,P＜0.05）.经Kaplan-Meier生存曲线分析表明,第6个月时血清cTnT≥0.1 μg/L的患者在（28.5±9.7）个月的随访期内心血管事件的发生率显著高于cTnT＜0.1μg/L的患者（Log-rank检验：P=0.02）.Cox回归分析表明,血清cTnT水平明显升高是心血管事件的独立预测因子.结论 cTnT水平可作为HD患者透析充分性的评价指标,对心血管事件有预测价值,规律的高通量HDF治疗有助于提高HD患者的透析充分性,改善患者的生存质量.

Objective To investigate the feasibility of serum cardiac troponin T（cTnT） as a marker of cardiovascular events and hemodialysis （HD） adequacy in maintainence hemodialysis （MHD） patients.Methods Forty-seven cases of MHD patients were randomly divided into two groups （group A and group B）.Group A received intermittent HD 4 h thrice one week,and group B received intermittent HD 4 h twice one week plus high-flux hemodiafiltration（HDF） 4 h once one week.Serum examination for blood biochemical indicator,cTnT and echocardiogram was performed every three months and at the time of recruitment.All the patients were followed up until the occurrence of death or cardiovascular events.Results After 3 months treatment,serum cTnT deceased significantly in group B compared with group A,and maintained the lower levels throughout the follow-up.E/A and LVEF had been reduced since 3 months treatment in group A,but stable in group B,E/A was lower in group A after 18 months treatment than that in group B,LVEF was lower in group A after 12 months treatment than that in group B.There were positive correlations between cTnT and E/A or LVEF in 42 cases who accomplished the follow-up of 12 months （r =0.54,0.66,P 〈0.05）.Kaplan-Meier survival curve showed that the occurrence of cardiovascular events in patients with cTnT≥0.1μ g/L was higher than that with cTnT 〈0.1 μg/L in （28.5 ± 9.7） months＇ follow- up （Log-rank test： P =0.02）.Both survival analysis and Cox analysis indicated that serum cTnT was a predictor of cardiovascular events in MHD patients.Conclusions Serum level of cTnT can be used as a marker of HD adequacy,and it is a predictor of cardiac events in MHD patients.Regular high-flux HDF increases the adequacy of HD treatment and improves the quality of life in MHD patients.