慢性肾脏病患者心肌肌钙蛋白T与心脏结构功能相关性研究

Correlation of Cardiac Troponin T and Cardiac Structure and Function in Patients with Chronic Kidney Disease

目的探讨非透析慢性肾脏病(chronic kidney disease,CKD)患者人群心肌肌钙蛋白T(cardiac troponin T,cTnT)与心脏结构功能的临床变化特点,并分析两者相关性。方法选取2014-01/2020-10月作者医院535例CKD非透析患者为研究对象,根据肾小球滤过率(glomerular filtration rate,GFR)确定CKD分期,根据CKD分期分成5组;根据患者cTnT水平进行四分位分组,分成4组。清晨空腹抽血检测血清cTnT水平,行超声心动图检测左房内径(left atrial diameter,LAD)、左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末内径(left ventricular end diastolic dimension,LVEDd)、舒张期左心室后壁厚度(left ventricular posterior wall thickness in diastole,LVPWTd)、舒张末期室间隔厚度(interventricular septal thickness in diastole,IVSTd)等指标,计算左心室质量指数(left ventricular mass index,LVMI)。比较CKD分组下cTnT水平变化特点以及CKD分组下心脏结构功能的变化,比较cTnT四分位分组下心脏结构功能变化。采用Pearson相关性分析评估cTnT与超声心动图各参数的相关性。结果随着CKD分期进展,cTnT水平以及LAD、LVEDd、LVPWTd、IVSTd、LVMI呈逐渐上升趋势,差异具有统计学意义(P<0.05)。在cTnT四分位分组下,随着cTnT水平升高,LAD、LVEDd、LVPWTd、IVSTd、LVMI呈逐渐上升趋势,差异具有统计学意义(P<0.05)。cTnT与上述心脏指标的相关性分析显示,cTnT与LAD、LVEDd、LVPWTd、IVSTd、LVMI呈正相关(r分别为0.176、0.221、0.155、0.129、0.235,P<0.05),与LVEF呈负相关(r=-0.122,P<0.05)。结论在CKD患者人群中,cTnT水平与心脏结构功能,随肾功能进展呈现出逐渐变化趋势,可为疾病病情进展及预后提供一个参考依据,同时CKD患者血清cTnT改变与心室结构和功能具有一定的相关性,对于CKD患者而言,cTnT可成为一种新的生物标志物,用于评估心脏风险。

Objective To investigate the clinical changes of cardiac troponin T(cTnT)and cardiac structure and function in patients with non-dialysis chronic kidney disease(CKD),and to analyze the correlation between the two.Methods A total of 535 non-dialysis patients with CKD in author′s hospital from January 2014 to October 2020 were selected.CKD stage was determined according to glomerular filtration rate(GFR).The patients were divided into 5 groups according to CKD stage.All patients were divided into 4 groups according to cTnT quartiles.Fasting blood samples were taken in the morning to detect serum cTnT level.The indicators of left atrial diameter(LAD),left ventricular ejection fraction(LVEF),left ventricularend diastolicb dimension(LVEDd),left ventricular posterior wall thickness in diastole(LVPWTd)and interventricular septal thickness in diastole(IVSTd)were detected by echocardiography,and left ventricular mass index(LVMI)was calculated.The changes of cTnT level in CKD group and cardiac structure and function in CKD group were compared,and the changes of cardiac structure and function under cTnT quartile grouping were compared as well.The correlation between cTnT and echocardiographic parameters was evaluated by Pearson correlation analysis.Results With the progression of CKD stage,cTnT level,LAD,LVEDd,LVPWTd,IVSTd and LVMI were gradually increased,and the difference was statistically significant(P<0.05).The level of cTnT increased gradually urder the cTnT quartile grouping,and the levels of LAD,LVEDd,LVPWTd,IVSTd and LVMI increased as well,and the difference was statistically significant(P<0.05).The correlation analysis between cTnT and the above-mentioned cardiac indexes showed that cTnT was positively correlated with LAD,LVEDd,LVPWTd,IVSTd and LVMI(r=0.176,0.221,0.155,0.129,0.235 respectively,P<0.05),and negatively correlated with LVEF(r=0.122,P<0.05).Conclusion Among patients with CKD,the level of cTnT and cardiac structure and function gradually change with the progress of renal function,which can provide a reference basis for the progression and prognosis of the disease.Meanwhile,there is a certain correlation between the changes of serum cTnT and ventricular structure and function in patients with CKD.For patients with CKD,cTnT can be used as a new biomarker to evaluate cardiac risk.