肌钙蛋白Ⅰ在老年2型糖尿病合并慢性肾功能衰竭病人中的临床意义

Clinical significance of TnI in elderly patients with type 2 diabetes mellitus complicated with chronic renal failure

目的探讨老年2型糖尿病合并慢性肾功能衰竭病人肌钙蛋白Ⅰ与肌酐、肾小球滤过率、C反应蛋白等多种因素之间的关系。方法选取60例老年男性病人,平均(73±11)岁,按肾功能分期标准分为3期和4期,检测并比较2组肌钙蛋白Ⅰ、肾小球滤过率、血脂、左室重量、血红蛋白等指标,同时分析肌钙蛋白与上述指标间的关系。结果肾病3期和4期病人在年龄、体质量、尿素氮、肌酐、甘油三酯、C反应蛋白、肾小球滤过率、血红蛋白、肌钙蛋白Ⅰ、左心室质量指数和肾阻力指数方面差异均有统计学意义(P<0.05)。分别将肾病3期和4期病人按肌钙蛋白Ⅰ水平分为升高组和正常组,结果显示3期和4期病人中,肌钙蛋白升高组和正常组的总胆固醇、血红蛋白、C反应蛋白、肾阻力指数、尿酸、左心室质量指数差异均有统计学意义。线性回归分析显示,肌钙蛋白I随肌酐(β=0.011,P=0.001)、C反应蛋白(β=0.008,P=0.018)、尿酸(β=0.016,P=0.021)水平的升高而升高。结论对于老年2型糖尿病合并慢性肾功衰的病人,肌钙蛋白Ⅰ不但是评价心肌损伤的标志物,也是反映残存肾脏功能及慢性肾衰竭程度的指标。

Objective To investigate the relationship between troponin Ⅰ（ Tn I） and creatinine,glomerular filtration rate,C-reactive protein and other related factors in elderly patients with type 2diabetes mellitus complicated with chronic renal failure. Methods Sixty elderly male patients were selected,with an average age of 73 ± 11 years old,and the rate of glomerular filtration was 44. 73 ±10. 56 ml/（ min·1. 73 m^2）. The patients were divided into stage 3 group and stage 4 group according to the renal function. The level of TnⅠ,glomerular filtration rate,blood lipids,left ventricular mass,hemoglobin and other indicators were detected and compared between the two groups. Results There were significant differences in age,weight,urea nitrogen,creatinine,triglyceride,C-reactive protein,glomerular filtration rate,hemoglobin,left ventricular mass index and renal resistance index between stage 3 group and stage 4 group. Furthermore,the patients were divided into increased group and normal group according to the levels of TnⅠ. Single factor analysis showed that the levels of total cholesterol,hemoglobin,C-reactive protein,renal resistance index,uric acid,and left ventricular mass index were of significant differences between increased group and normal group both in stage 3 or stage 4. TnⅠ increased with the increasing level of creatinine,C-reactive protein and uric acid.Conclusions TnⅠ is not only a marker of myocardial injury in patients with type 2 diabetic nephropathy complicated with chronic renal failure,but also an indicator of residual renal function and chronic renal failure.