心脏标志物检测在肾脏功能不全患者中的应用价值

Application value of serum cardiac marker detection in patients with renal dysfunction

目的：探讨肾脏功能不全患者血清高敏肌钙蛋白 T（hs-cTnT）、肌红蛋白（MYO）、肌酸激酶同工酶（CK-MB）质量（CK-MB mass）及 B 型氨基端钠尿肽原（NT-proBNP）水平变化。方法收集2013年5～9月宜宾市第二人民医院住院诊断为肾功能不全患者（排除心脏骨骼肌疾病），根据血尿素和肌酐浓度分为代偿期组30例，失代偿期组24例，尿毒症组22例以及36例健康体检者（对照组）。空腹采集静脉血液，分离血清，用电化学发光免疫分析法检测其血清 hs-cTnT、MYO、CK-MB mass 和 NT-proBNP 水平。结果代偿期组、失代偿期组、尿毒症组及对照组血清 hs-cTnT 水平分别为16．4（10．9～24．2）、17．0（13．0～25．5）、25．9（16．5～33．8）和13．7（9．4～19．7）pg/mL；血清 MYO 水平分别为52．4（40．0～96．5）、87．9（57．7～118．3）、115．7（94．2～175．8）和34．8（24．3～48．1）ng/mL；血清 CK-MB mass 水平分别为1．03（0．82～1．75）、1．31（1．08～1．69）、1．66（1．01～2．46）和1．88（1．63～2．43）ng/mL；血清 NT-proBNP 水平分别为292．5（123．3～576．2）、363．3（192．3～893．3）、1357．2（536．5～4662．9）和110．3（70．1～196．3）ng/mL。各组血清 hs-cTnT、MYO 及 NT-proBNP 随肾功能下降，水平逐渐增加。经非参数 Kruskal-Wallis H 检验，差异有统计学意义（H 值分别为14．46、49．81和35．00，P ＜0．05）；各组血清 CK-MB mass 水平比较差异无统计学意义（P ＞0．05）。结论肾功能不全患者合并有较高的心血管事件风险率，早期检测心脏标志物有助于诊断心肌损伤及评估未来发生心肌梗死风险率，诊断心衰及评估未来发生心衰风险率。

Objective To explore the change of serum high-sensitivity cardiac troponin T（hs-cTnT）,myoglobin（MYO）,creatine kinase isoenzyme（CK-MB）mass（CK-MB mass）and N-terminal pro-brain natriuretic peptide（NT-proBNP）levels in the patients with renal dysfunction.Methods The inpatients with renal dysfunction（excluding cardiac and skeletal muscle diseases）in our hos-pital were collected and divided into the compensation period group（30 cases）,decompensation period group（24 cases）and uremia group（22 cases）according to serum urea and creatine concentration,and 36 healthy individuals were selected as the control group. Venous blood was collected on an empty stomach and separated for obtaining serum.Serum levels of hs-cTnT,MYO,CK-MB mass and NT-proBNP were measured by the electrochemiluminescent immunoassay.Results Serum hs-cTnT levels in the compensation period group,decompensation period group,uremia group and the control group were 16.4（10.9-24.2）,17.0（13.0-25.5）,25.9 （16.5-33.8）,13.7（9.4 -19.7 ）pg/mL respectively.Serum MYO levels were 52.4 （40.0 -96.5 ）,87.9 （57.7 -118.3 ）,115.7 （94.2-175.8）,34.8（24.3-48.1）ng/mL,respectively.Serum CK-MB mass levels were 1.03（0.82 -1.75）,1.31 （1.08 -1.69）, 1.66（1.01-2.46）,1.88（1.63-2.43）ng/mL,respectively.Serum NT-proBNP levels were 292.5（123.3-576.2）,363.3（192.3-893.3）,1 357.2（536.5 -4 662.9）,110.3 （70.1 -196.3）ng/mL,respectively.The serum hs-cTnT,MYO and NT-proBNP levels were increased with renal function decrease.The nonparametric Kruskal-Wallis H test showed statistically significant difference a-mong groups（H =14.46,49.81 and 35.00,P ＆lt;0.05 ）.The CK-MB mass level had no statistically significant difference among groups（P ＆gt;0.05）.Conclusion The patients with renal dysfunction have the higher risk rate for complicating the cardiovascular e-vents.Early detection of cardiac markers conduces to the diagnosis of myocardial injury,the evaluation of the risk rate of myocardial infarction occurrence in future and the diagnosis of heart failure and evaluation of the risk rate of heart failure occurrence in future.