摘要
目的:研究维持性血液透析(MHD)患者血清超敏肌钙蛋白T(hs-c Tn T)水平与左室舒张功能障碍(LVDD的关系,探讨hs-c Tn T用于早期筛查血液透析患者LVDD的可行性。方法:收集我院152例MHD患者的资料,电化学法检测血清hs-c Tn T浓度,组织多普勒(TDI)测量参数E/E’>15或E’<7 cm/s作为评价LVDD的主要标准。Spearman相关分析和多元回归分析评估血清hs-c Tn T水平与E/E’和E’的相关性,ROC曲线评价血清hs-c Tn T水平用于预测LVDD的敏感性和特异性。结果:152例患者血清hs-c Tn T中位数为45(28~73) pg/ml。88%的患者hs-c Tn T水平高于正常值上限。单因素相关分析显示血清hs-c Tn T水平与E/E'比值(r=0. 739,P <0. 001)及左室质量指数(LVMI)(r=0. 608,P <0. 001)呈正相关,与E’值(r=-0. 554,P <0. 001)呈负相关。校正了LVMI及容量等因素后,血清hs-c Tn T仍与E/E’及E’独立相关。而hs-c Tn T与左室收缩功能无关。hs-c Tn T用于预测E/E’>15的ROC曲线下面积为0.847,最佳临界值为48.7 pg/ml(敏感性为81. 3%,特异性为75. 3%)。用于预测E’<7 cm/s的ROC曲线下面积为0. 799,最佳临界值为46. 7 pg/ml(敏感性为75. 4%,特异性为70. 3%)。结论:我们的研究表明,血清hs-c Tn T可作为筛查MHD患者LVDD的一项有效的血清学标志物。
Objective:To identify the relationship between serum high-sensitive cardiac troponin T (hs-cTnT) and left ventricular diastolic dysfunction (LVDD) among maintenance hemodialysis (MHD)patients and to further explore the value of hs-cTnT in evaluating and predicting LVDD in this special group of patients. Methods:152 MHD patients with end stage renal disease (ESRD) involved in this cross-sectional study. Demographic,biochemical,and echocardiographic values were collected. TDI parameters of E/E’ and E' are the essential part of evaluating diastolic function by echocardiography. E/E’>15 or E’<7 cm/s was defined as diastolic dysfunction. The relationship between serum hs-cTnT and LVDD parameters was analyzed using spearman's rank correlation and multivariate regression analysis,and its value on assessing LVDD was evaluated by receiver-operating characteristic (ROC) curves. Results:The median value of hs-cTnT was 45 pg/ml (range 28~73 pg/ml). All patients had detectable hs-cTnT,while 88% of them had greater hs-cTnT than the 99th percentile of the general population (14 pg/ml). Serum hs-cTnT values showed a significantly positive correlation with E/E’( r=0.739,P <0.001) and LVMI ( r=0.608,P <0.001),but showed a significantly negative correlation with E’( r=-0.554,P <0.001). The associations of higher hs-cTnT with E/E’ and E’ persisted after multivariate adjustment for LVMI and volume status,however there was no significant independent association between hs-cTnT and LV systolic dysfunction. The area under the ROC curve (AUC) for hs-cTnT evaluating E/E’>15 was 0.847 and the best critical value was 48.7 pg/ml (sensitivity 81.3%,specificity 75.3%). The AUC of the ROC curve for hs-cTnT evaluating E’< 7 cm/s was 0.799 and the best critical value was 46.7 pg/ml (sensitivity 75.4%,specificity 70.3%) for E’<7 cm/s. Conclusion:Our studies suggest that serum hs-cTnT may serve as a biomarker of LVDD in hemodialysis patients.
作者
孙琳琳
朱鼎玉
陈富华
王永兰
谢新苗
丁淼
张楠
王彦哲
王筱霞
SUN Linlin;ZHU Dingyu;CHEN Fuhua(Deparment of Nephrology,Tongren Hospital Affiliated to Medical College of Shanghai Jiaotong University,Shanghai,200336)
出处
《中国中西医结合肾病杂志》
2019年第2期113-116,共4页
Chinese Journal of Integrated Traditional and Western Nephrology
基金
上海市长宁区卫生和计划生育委员会科研项目(No.20174Y004)
国家自然科学基金面上项目(No.81770718)
关键词
超敏肌钙蛋白T
左室舒张功能障碍
终末期肾衰
肾透析
High-sensitive cardiac troponin T
Left ventricular diastolic dysfunction
End stage renal disease
Hemodialysis