糖尿病肾病合并心肌肌钙蛋白T阳性的临床意义

The Observation of Cardiovascular Events and Serum Cardiac Troponin T in Patients with Diabetic Nephropathy

目的探讨糖尿病肾病患者血清心肌钙蛋白T(cTnT)升高的临床意义。方法选择2型糖尿病肾病住院患者180例(均排除近3个月内曾发生急性心肌梗死),测定血清cTnT、随机血糖(RBG)、果糖胺(FA)、糖化血红蛋白(HbA1C)、肝、肾功能、血脂、C反应蛋白(CRP)。随访90d,观察患者心血管事件及死亡事件的发生情况,分析其与cTnT的关系。结果 180例糖尿病患者血清cTnT升高25例,其中尿白蛋白<30mg/d组(A组,60例)中cTnT升高1例;尿白蛋白30～300mg/d组(B组,60例)cTnT升高4例;尿白蛋白>300mg/d或血清肌酐(Scr)高于参考值组(C组,60例)cTnT升高20例。cTnT升高患者中发生心血管事件16例,死亡8例,7例死于心血管事件;cTnT正常155例中发生心血管事件6例,死亡4例,其中1例死于心血管事件。两组比较差异有统计学意义(P<0.01)。结论随着糖尿病肾病进展,cTnT升高阳性率增加;糖尿病肾病合并血清cTnT水平升高可能是心血管高风险预测因素。

Objective To observe the clinical relation of cardiovascular events with elevated serum cardiac troponin T （cTnT） in patients with diabetic nephropathy. Methods 180 inpatients with diabetic nephropathy who were all excluded suffering of acute myocardial infarction in last three months were selected anf their serum cTnT, random blood glucose, fructosamine, glycated hemoglobin, hepatic function, renal function, blood lipids, C reactive protein were examined. In 90-days follow-up, the incidence of cardiovascular events and death were observed, and the relationship between the incidence and cTnT was analyzed. Results There were 25 patients with elevated cTnT among the total 180 cases. One case had increased cTnT in group A （urinary albumin〈 30 mg/d, 60 cases）, 4 cases increased in group B （urinary albumin 30-300 mg/d, 60 cases）, and 20 cases in group C （urinary albumin 〉300 mg/d or Cr higher than the reference value, 60 cases）. Among the inpatients with increased serum cTnT, there were 16 patients suffered with cardiovascular events, and 7 cases of total 8 death patients died of cardiovascular events. Among 155 eTnT normal patients, cardiovascular events occurred in 6 patients and there were 4 cases died, 1 of which died of cardiovascular events. The differences between two groups were significant （P〈0.01）. Conclusion With the progress of diabetic nephropathy, the positive rate of elevated cTnT increases; elevated serum cTnT in diabetic nephropathy may predict the high risk for cardiovascular events.