高敏肌钙蛋白T对肾脏受损的急性心肌梗死患者诊断准确性研究

Diagnosis accuracy of acute myocardial infarction in patients with renal injury using high-sensitivity troponin T

目的探讨高敏肌钙蛋白T(hs-cTnT)对肾脏受损的急性心肌梗死(AMI)患者诊断准确性。方法根据估算肾小球滤过率(eGFR)不同将纳入研究的1934例出现胸痛的患者进行分组,分别为eGFR≥90 mL/(min·1.73 m^(2))组[慢性肾脏病(CKD)Ⅰ期]689例、eGFR 60~<90 mL/(min·1.73 m^(2))组(CKDⅡ期)889例、eGFR 30~<60 mL/(min·1.73 m^(2))组(CKDⅢ期)283例和eGFR<30 mL/(min·1.73 m^(2))组(CKDⅣ期)73例。比较各组受试者工作特征(ROC)曲线的确定阈值与第99百分位数对应诊断性能差异。结果在eGFR<30 mL/(min·1.73 m^(2))、eGFR 30~<60 mL/(min·1.73 m^(2))及eGFR 60~<90 mL/(min·1.73 m^(2))中,ROC确定阈值与第99百分位数对应敏感度、特异度、阳性预测值、阴性预测值比较,差异均有统计学意义(P<0.01)。结论若需使用hs-cTnT准确诊断肾脏受损的AMI患者,其ROC阈值需结合eGFR。

Objective To investigate the diagnostic accuracy of high-sensitivity cardiac troponin T(hs-cTnT)in patients with acute myocardial infarction(AMI)with renal damage.Methods A total of 1934 patients with chest pain were divided into different groups based on different estimated glomerular filtration rate(eGFR).There were 689 cases in the group of eGFR≥90 mL/(min·1.73 m^(2))[chronic kidney disease(CKD)Ⅰstage],889 cases in the group of eGFR 60 to<90 mL/(min·1.73 m^(2))(CKDⅡstage),283 cases in the group eGFR 30 to<60 mL/(min·1.73 m^(2))(CKDⅢstage)and 73 cases in the eGFR<30 mL/(min·1.73 m^(2))group(CKDⅣstage).Receiver operating characteristic(ROC)curve was used to compare the diagnostic performance between the threshold and the 99th percentile.Results When eGFR<30 mL/(min·1.73 m^(2)),eGFR 30 to<60 mL/(min·1.73 m^(2))and eGFR 60 to<90 mL/(min·1.73 m^(2)).Compared with the corresponding sensitivity,specificity,positive predictive value and negative predictive value of the 99th percentile,and the differences in those of the ROC determination threshold were statistically significant(P<0.01).Conclusion For AMI patients with kidney damage,the ROC threshold hs-cTnT should be combined with eGFR for accurate diagnosis.