维持性血液透析患者心肌酶变化及其临床意义探讨
摘要
目的:测定维持性血液透析患者肌酸磷酸激酶-MB同工酶(CK-MB)、血清肌钙蛋白T(cTnT)、血清肌钙蛋白I(cTnI)的水平并探讨其预测心血管事件的价值。方法:连续收集2014年01月～2016年01月期间在我院维持性血液透析患者60例,另选取60例无肾功能损害的体检者作为对照组,同时检测两组肌酸磷酸激酶-MB同工酶(CK-MB)、血清肌钙蛋白T(cTnT)、血清肌钙蛋白I(cTnI)的水平,每6个月测定1次,随访2年,观察心血管事件发生情况,分析其与心肌酶水平关系。结果:与对照组相比,维持性血液透析组CK-MB水平无统计学差异,cTnT、cTnI的水平均升高(P <0. 01),60例维持性血液透析患者中cTnT阳性组心血管事件发生率53. 8%,cTnT阴性组心血管事件发生率10. 6%(P <0. 01); cTnI阳性组心血管事件发生率75. 0%,cTnI阴性组心血管事件发生率11. 5%(P <0. 01); cTnT及cTnI均升高5例,5例均发生心血管事件。结论:维持性血液透析患者血清cTnT及cTnI水平均升高,联合测试cTnT及cTnI可以更精确地找出维持性血液透析患者心血管事件发生的高危患者。
引文
1. Parfrey PS,Foley RN,Thamer C,et al. The clinical epidemiology of cardiac disease in ehronio renal failure. J Am Soc Nephrol,1999,10(8):1606-1615.
2 . Choy JB,Armstrong PW,Ulan RA,et al. Do cardiac troponin provide prognostic in sight in hemodialysis patients. Can J Cardiol,2003,19(5):907-1111.
3 . United States Renal Data System.“Atlas of end-stage renal disease in United States”USRDS 2006 Annual Data Report,National Institute of Diabetes and digestive and Kidney Diseases. Bethesda Md USA,2006.
4 .钱春梅,王秦,李军辉,等.维持性血液透析患者死亡原因的临床分析.中国中西医结合肾病杂志,2015,16(2):116-120.
5 . Gaiki MR,Devota MV,Michelis MF,et al. Troponin I as a prognostic marker of cardiac events in asymptomatic hemodialysis patients using a sensitive troponin I assay. Int Urol Nephrol,2012,44(6):1841-1845.
6 .徐志勇,暨利军,张月珍,等.血液透析患者血清肌钙蛋白I检测对心血管病的预测价值.中国中西医结合肾病杂志,2011,12(11):1002-1004.
7 . Ooi DS,Zimmerman D,Graham J,et al. Cardiac troponin T predicts long-term outcomes in hemodialysis patients. Clin Chem,2001,47(3):412-417.
8 . Wang AY,Wai-Kei Lam C,Twerenbold R,et al. The diagnostic utility of cardiac biomarkers in dialysis patients. Seminars in dialysis,2012,25(4):388-396.
9 . Artunc F,Mueller C,Breidthardt T,et al. Sensitive troponinswhich suits better for hemodialysis patients Associated factors and prediction of mortality. Plo S one,2012,7(10):e47610.
10 . Kumar N,Michelis MF,De Vita MV,et al. Troponin I levels in asymptomatic patients on haemodialysis using a high-sensitivity assay. Nephrology,dialysis,transplantation:official publication of the European Dialysis and Transplant Association-European Renal Association,2011,26(2):665-670.
11 . Apple FS,Murakami MM,Pearce La,et al. Predictive value of cardiac troponin I and T for subsequent death in end-stage renal disease. Circulation,2002,106(23):2941-2945.
2 . Choy JB,Armstrong PW,Ulan RA,et al. Do cardiac troponin provide prognostic in sight in hemodialysis patients. Can J Cardiol,2003,19(5):907-1111.
3 . United States Renal Data System.“Atlas of end-stage renal disease in United States”USRDS 2006 Annual Data Report,National Institute of Diabetes and digestive and Kidney Diseases. Bethesda Md USA,2006.
4 .钱春梅,王秦,李军辉,等.维持性血液透析患者死亡原因的临床分析.中国中西医结合肾病杂志,2015,16(2):116-120.
5 . Gaiki MR,Devota MV,Michelis MF,et al. Troponin I as a prognostic marker of cardiac events in asymptomatic hemodialysis patients using a sensitive troponin I assay. Int Urol Nephrol,2012,44(6):1841-1845.
6 .徐志勇,暨利军,张月珍,等.血液透析患者血清肌钙蛋白I检测对心血管病的预测价值.中国中西医结合肾病杂志,2011,12(11):1002-1004.
7 . Ooi DS,Zimmerman D,Graham J,et al. Cardiac troponin T predicts long-term outcomes in hemodialysis patients. Clin Chem,2001,47(3):412-417.
8 . Wang AY,Wai-Kei Lam C,Twerenbold R,et al. The diagnostic utility of cardiac biomarkers in dialysis patients. Seminars in dialysis,2012,25(4):388-396.
9 . Artunc F,Mueller C,Breidthardt T,et al. Sensitive troponinswhich suits better for hemodialysis patients Associated factors and prediction of mortality. Plo S one,2012,7(10):e47610.
10 . Kumar N,Michelis MF,De Vita MV,et al. Troponin I levels in asymptomatic patients on haemodialysis using a high-sensitivity assay. Nephrology,dialysis,transplantation:official publication of the European Dialysis and Transplant Association-European Renal Association,2011,26(2):665-670.
11 . Apple FS,Murakami MM,Pearce La,et al. Predictive value of cardiac troponin I and T for subsequent death in end-stage renal disease. Circulation,2002,106(23):2941-2945.