超敏肌钙蛋白对维持性血液透析患者的短期预后作用

 目的 探讨超敏肌钙蛋白(high-sensitivity cardiac troponin T, hs-cTnT)对维持性血液透析(maintainance hemodialysis, MHD)患者的短期预后作用。方法 入组296例MHD患者,回顾性分析其临床资料,患者血液透析前采集血清检测hs-cTnT和相关心血管风险标志物。随访时间总长为13个月,记录主要终点事件(全因死亡)及发生时间;用t检验、Mann-Whitney U检验和χ2检验分析比较全因死亡与生存组风险标志物之间的差异,使用X-tile计算出hs-cTnT的最佳二分位切点,绘制Kaplan-Meier生存曲线,用Logistic回归分析高危及非高危hs-cTnT之间的死亡风险比。根据hs-cTnT健康人群第99百分位点将非高危组细分为中危组和低危组来进一步评估其对MHD患者短期预后的影响。结果 MHD患者生存与全因死亡组的血清hs-cTnT水平分别为0.05 (0.03~0.07)ng/mL和0.07(0.04~0.14)ng/mL (P=0.027);hs-cTnT的最佳二分位切点为0.1 ng/mL;高危组(hs-cTnT>0.1 ng/mL)患者生存率(76.67%)显著低于非高危组(hs-cTnT≤0.1 ng/mL)患者生存率(96.62%)(P<0.05);高危组患者死亡风险较非高危组患者高7.288倍(P<0.001);在非高危人群组中,中危组(hs-cTnT>0.014 ng/mL)患者生存率低于低危组(hs-cTnT≤0.014 ng/mL)患者生存率,低危组在随访期间无死亡事件发生。结论 hs-cTnT是MHD患者死亡的独立危险因素,并可作为MHD患者短期的死亡风险分级和预后评估的有力指标。

The short-term prediction of high-sensitivity cardiac troponin T in patients undergoing maintenance hemodialysis

Objective To evaluate the short-term prediction of high-sensitivity cardiac troponin T (hs-cTnT) and other cardiovascular risk biomarkers in patients undergoing maintenance hemodialysis (MHD). Methods We conducted a cohort survey in 296 consecutive MHD patients whose clinical data were retrospectively analyzed. Before MHD, hs-cTnT and other relative cardiovascular biomarkers were detected. The end point (all-cause death) and time of occurring were recorded in the next 13 months. The differences between survival and all-cause death were analyzed by t-test, Mann-Whitney test and χ2 test. The best two percentile cutoff point was calculated by X-tile and the survival rate was calculated by Kaplan-Meier Logistic regression analysis was applied to analyze the odd ratio between high risk and non-high risk hs-cTnT group. Non-high risk group was divided into intermediate risk and low risk group based on the 99th percentile of hs-cTnT in healthy population, to further evaluate its short-term prediction value for MHD patients. The short-term significance of hs-cTnT was proved to be independently associated with all-cause death by Logistic regression analysis. Results The mean value of serum hs-cTnT in survival group was 0.05 (0.03~0.07) ng/mL, while in the death group it was 0.07 (0.04~0.14) ng/mL, which had statistical significance (P=0.027). The best two percentile cutoff of hs-cTnT in MHD patients was 0.1 ng/mL. The survival rate in high risk group (hs-cTnT>0.1 ng/mL) is lower than it in non-high risk group (hs-cTnT≤0.1 ng/mL) (76.67% vs.96.62%,P<0.05). The odd ratios for high risk group and non-high risk group was 7.288 (P<0.001). Moreover, further grouping the non-high risk group by hs-cTnT=0.014 ng/mL, intermediate risk group (hs-cTnT>0.014 ng/mL) group has lower survival rate than low risk group (hs-cTnT≤0.014 ng/mL), while there wasn’t any death case occurred in the low risk group. Conclusions Hs-cTnT is an independent risk factor to all-cause death. Thus hs-cTnT can be a strong indicator of short term prediction and prognostic evaluation.