心肌损伤标记物对慢性肾脏病非透析患者评估心脏结构功能的预测

目的 探讨心肌损伤标记物血浆高敏心肌肌钙蛋白T (hs-c Tn T) 、N末端B型利钠肽原 (NT-pro BNP) 、肌酸激酶同工酶 (CK-MB) 的水平对不同时期的慢性肾脏病 (CKD) 非透析患者的预测价值.方法 选取CKD非透析患者共137例, 检测心肌损伤标记物, 做超声心动图等检查, 由ROC曲线下面积评价诊断价值.结果血浆hs-c Tn T、NT-pro BNP、CK-MB在CKD5期组最高, CKD3-4期组高于CKD1-2期组.左心室肥厚 (LVH) 和左室舒张功能不全 (E/A<1) 在CKD5期组和CKD3-4期组低于CKD1-2期组.有LVH和E/A<1患者hs-c Tn T、NT-pro BNP、CK-MB水平显著高于无LVH和E/A<1患者.用ROC曲线分析CKD患者心肌损伤标记物对LVH和E/A<1评估, 敏感性和特异性最高是CK-MB, 其次NT-pro BNP, hs-c Tn T, P<0.001.结论 CKD非透析患者心肌损伤标记物水平随着肾功能恶化而进行性升高, 且与心脏结构功能密切相关, CK-MB在诊断LVH和E/A<1的准确性最高.

Clinical Value of Myocardial Injury Markers in Evaluating Cardiac Structure and Function of Chronic Kidney Disease Patients without Dialysis

Objective To study the changes of myocardial injury markers hs-c Tn T, NT-pro BNP and CK-MB levels in CKD patients without dialysis in different stags and their value for outcome prediction. Methods A total of 137 cases of non-dialysis patients with chronic kidney disease were enrolled in this cross-sectional study.The myocardial injury markers hs-c Tn T, NT-pro BNP, CK-MBH and cardiac ultrasonography were examined. And the area under ROC was measured and compared to evaluate the value of different biomarkers in predicting cardiac dysfunction and outcome. Results The levels of plasma hs-c Tn T, NT-pro BNP and CK-MB in CKD5 group were the highest in the three groups, and the biomarlers in CKD3-4 group was significantly higher than CKD1-2 group (P<0.001) . The expression of LVH and the E/A <1, LVH in CKD5 group and CKD3-4 group were lower than CKD1-2 (P<0.001) .The levels of plasma hs-c Tn T, NT-pro BNP and CK-MB in the patients with CKD were measured and the left ventricular hypertrophy was evaluated by the curve of the working curve of the subjects.Through the ROC curve, the CK-MB had the highest accuracy of left ventricular hypertrophy, followed by NT-pro BNP and hs-c Tn T. Conlusions Levels of hs-c Tn T, NT-pro BNP and CK-MB are elevated in patients with CKD. CK-MB is a good biomarker in predicting cardic dysfunction of CKD patients with early cardiovascular disease.