高敏肌钙蛋白T和肌红蛋白在肾功能不全患者中的变化及意义
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摘要
目的评估高敏肌钙蛋白T(hs-cTnT)、肌红蛋白(MYO)与肾功能的关系,探讨两者在肾功能不全患者中的临床意义。方法收集2017年1-5月南京医科大学第一附属医院肾科住院患者共205例,分别检测hs-cTnT,MYO和肌酐(Cr)水平,估算肾小球滤过率(eGFR),依据eGFR数值将患者分为5期。采用SPSS22.0软件进行统计分析,分别计算各期患者的hs-cTnT和MYO的中位数、最小值和最大值,分析两者与Cr、eGFR的相关性,并对不同时期的hs-cTnT、MYO水平进行比较。结果1~5期hs-cTnT水平分别为13.48(4.13~61.01)ng/L、18.83(8.60~230.40)ng/L、29.38(7.35~636.20)ng/L、49.16(8.93~556.20)ng/L、78.71(8.64~793.00)ng/L;MYO水平分别为21.00(5.00~160.00)g/L、24.00(11.00~104.00)μg/L、45.00(11.00~507.00)μg/L、71.50(5.00~1 000.00)μg/L、106.00(17.00~1 000.00)μg/L。hs-cTnT、MYO分别与eGFR呈负相关(r=-0.487、-0.589,P<0.05),与Cr呈正相关(r=0.459、0.589,P<0.05)。各期hs-cTnT及MYO随肾功能水平下降而逐渐升高。各期hs-cTnT、MYO水平比较,差异有统计学意义(P<0.05)。结论 hs-cTnT、MYO对于肾功能不全患者早期发现心血管事件具有重要意义,同时随着肾脏疾病的进展而明显增加,提示两者可作为监测肾功能的指标。
Objective To evaluate the relationship between high-sensitivity troponin T(hs-cTnT),myoglobin(MYO)and renal function,and to explore the clinical significance in patients with renal insufficiency.Methods The levels of hs-cTnT,MYO and creatinine(Cr)were measured in 205 patients with Kidney disease from the First Affiliated Hospital of Nanjing Medical University from January to May in 2017.The estimated value of glomerular filtration rate(eGFR)were calculated.According to the eGFR,the patients were divided into five stages.SPSS 20.0 software was used to analyze the levels of the two indexes in 5 stages and analyze the relationship between hs-cTnT,MYO and Cr,eGFR and compare the levels of hs-cTnT and MYO in different stages in patients.The difference were statistically significant(P<0.05).Results The levels of hs-cTnT were 13.48(4.13-61.01)ng/L,18.83(8.60-230.40)ng/L,29.38(7.35-636.20)ng/L,49.16(8.93-556.20)ng/L,78.71(8.64-793.00)ng/L in the 5 stages.The levels of MYO were 21.00(5.00-160.00)μg/L,24.00(11.00-104.00)μg/L,45.00(11.00-507.00)μg/L,71.50(5.00-1 000.00)μg/L,106.00(17.00-1 000.00)μg/L in the 5 stages.Hs-cTnT and MYO were negatively correlated with eGFR(r=-0.487,-0.589,P<0.05),and were positively correlated with Cr(r=0.459,0.589,P<0.05).The levels of hs-cTnT and MYO were gradually increased with the decrease of renal function.There were significant differences in levels of hs-cTnT and MYO in different stages(P<0.05).Conclusion This study found that hs-cTnT,MYO are important for the early detection of cardiovascular events in patients with renal insufficiency,and they increase with the development of renal disease,indicating that hs-cTnT and MYO may be used as indexes to monitor renal function.
Objective To evaluate the relationship between high-sensitivity troponin T(hs-cTnT),myoglobin(MYO)and renal function,and to explore the clinical significance in patients with renal insufficiency.Methods The levels of hs-cTnT,MYO and creatinine(Cr)were measured in 205 patients with Kidney disease from the First Affiliated Hospital of Nanjing Medical University from January to May in 2017.The estimated value of glomerular filtration rate(eGFR)were calculated.According to the eGFR,the patients were divided into five stages.SPSS 20.0 software was used to analyze the levels of the two indexes in 5 stages and analyze the relationship between hs-cTnT,MYO and Cr,eGFR and compare the levels of hs-cTnT and MYO in different stages in patients.The difference were statistically significant(P<0.05).Results The levels of hs-cTnT were 13.48(4.13-61.01)ng/L,18.83(8.60-230.40)ng/L,29.38(7.35-636.20)ng/L,49.16(8.93-556.20)ng/L,78.71(8.64-793.00)ng/L in the 5 stages.The levels of MYO were 21.00(5.00-160.00)μg/L,24.00(11.00-104.00)μg/L,45.00(11.00-507.00)μg/L,71.50(5.00-1 000.00)μg/L,106.00(17.00-1 000.00)μg/L in the 5 stages.Hs-cTnT and MYO were negatively correlated with eGFR(r=-0.487,-0.589,P<0.05),and were positively correlated with Cr(r=0.459,0.589,P<0.05).The levels of hs-cTnT and MYO were gradually increased with the decrease of renal function.There were significant differences in levels of hs-cTnT and MYO in different stages(P<0.05).Conclusion This study found that hs-cTnT,MYO are important for the early detection of cardiovascular events in patients with renal insufficiency,and they increase with the development of renal disease,indicating that hs-cTnT and MYO may be used as indexes to monitor renal function.
引文
[1]肖文凯,叶平.慢性肾脏病患者血清高敏肌钙蛋白T水平变化及意义[J].中华老年心脑血管病杂志,2015,17(5):546-548.
[2]鄢盛恺.高敏感心肌肌钙蛋白检测的临床应用[J].中华检验医学杂志,2010,33:809-813.
[3]APPLE F S,COLLINSON P O.Analytical characteristics of high-sensetivity cardiac troponin assays[J].Clin Chem,2012,58:54-61.
[4]Causes of death.United states renal data system[J].Am J Kidney Dis.1998,32(2Suppl 1):S81-88.
[5]LEVEY A S,STEVENS L A.Estimating GFR using the CKD epidemiology collaboration(CKD-EPI)creatinine equation:more accurate GFR estimates,lower CKD prevalence estimates,and better risk predictions[J].Am J Kidney Dis,2010,55(4):622-627.
[6]刘蔓莉,王平,龚蓉.慢性肾功能衰竭维持性血液透析患者血清肌钙蛋白T水平的变化及意义[J].实用临床医学,2007,8(7):5-7.
[7]FOLEY R N,PARFREY P S,SARNAK M J.Clinical epidemiology of cardiovascular disease in chronic renal disease[J].Am J Kidney Dis,1998,32(5):112-119.
[8]CERASOLA G,NARDI E,MULE G,et al.Left ventricular mass in hypertensive patients with mild-to-moderate reduction of renal function[J].Nephrology(Carlton),2010,15(2):203-210.
[9]干艳捷,章艳萍,何琼.慢性肾功能衰竭患者心肌肌钙蛋白T水平的临床观察[J].山西医药杂志,2011,9(40):923-924.
[10]谭若芸,赵卫红.慢性肾功能衰竭患者血清肌钙蛋白T/I的变化及其临床意义[J].国外医学泌尿系统分册,2003,23(5):571-573.
[11]于晓丽.高敏肌钙蛋白T检测在心肌梗死中应用价值的研究[J].中国卫生检验杂志,2012,22(1):119-120.
[12]李芬,朱现菊.高敏心肌肌钙蛋白T水平与维持性血液透析患者心脏结构和功能的关系[J].中国血液净化,2014,13(5):377-379.
[13]周宏久,姚翠微,陶静莉.慢性肾衰竭患者血清肌红蛋白、肌钙蛋白I校正公式的建立[J].中国实验诊断学,2013,17(3):515-518.
[14]COLLINSON P O,BOA F C,GAZE D C.Measurement of cardiactroponins[J].Clin Biochem,2001,38:423.
[15]李光富,向小节,郭小聪,等.心脏标志物检测在肾功能不全患者中的应用价值[J].国际检验医学杂志,2014,35(16):2149-2153.
[2]鄢盛恺.高敏感心肌肌钙蛋白检测的临床应用[J].中华检验医学杂志,2010,33:809-813.
[3]APPLE F S,COLLINSON P O.Analytical characteristics of high-sensetivity cardiac troponin assays[J].Clin Chem,2012,58:54-61.
[4]Causes of death.United states renal data system[J].Am J Kidney Dis.1998,32(2Suppl 1):S81-88.
[5]LEVEY A S,STEVENS L A.Estimating GFR using the CKD epidemiology collaboration(CKD-EPI)creatinine equation:more accurate GFR estimates,lower CKD prevalence estimates,and better risk predictions[J].Am J Kidney Dis,2010,55(4):622-627.
[6]刘蔓莉,王平,龚蓉.慢性肾功能衰竭维持性血液透析患者血清肌钙蛋白T水平的变化及意义[J].实用临床医学,2007,8(7):5-7.
[7]FOLEY R N,PARFREY P S,SARNAK M J.Clinical epidemiology of cardiovascular disease in chronic renal disease[J].Am J Kidney Dis,1998,32(5):112-119.
[8]CERASOLA G,NARDI E,MULE G,et al.Left ventricular mass in hypertensive patients with mild-to-moderate reduction of renal function[J].Nephrology(Carlton),2010,15(2):203-210.
[9]干艳捷,章艳萍,何琼.慢性肾功能衰竭患者心肌肌钙蛋白T水平的临床观察[J].山西医药杂志,2011,9(40):923-924.
[10]谭若芸,赵卫红.慢性肾功能衰竭患者血清肌钙蛋白T/I的变化及其临床意义[J].国外医学泌尿系统分册,2003,23(5):571-573.
[11]于晓丽.高敏肌钙蛋白T检测在心肌梗死中应用价值的研究[J].中国卫生检验杂志,2012,22(1):119-120.
[12]李芬,朱现菊.高敏心肌肌钙蛋白T水平与维持性血液透析患者心脏结构和功能的关系[J].中国血液净化,2014,13(5):377-379.
[13]周宏久,姚翠微,陶静莉.慢性肾衰竭患者血清肌红蛋白、肌钙蛋白I校正公式的建立[J].中国实验诊断学,2013,17(3):515-518.
[14]COLLINSON P O,BOA F C,GAZE D C.Measurement of cardiactroponins[J].Clin Biochem,2001,38:423.
[15]李光富,向小节,郭小聪,等.心脏标志物检测在肾功能不全患者中的应用价值[J].国际检验医学杂志,2014,35(16):2149-2153.