维持性血液透析患者血清心肌肌钙蛋白T和C反应蛋白水平与预后的关系

目的探讨维持性血液透析(MHD)患者血清心肌肌钙蛋白T(cTnT)和C反应蛋白(CRP)对其心脑血管疾病及死亡的预测价值。方法选择在北京医院进行维持性血液透析的患者106例。检测透析前血清cTnT、CRP、Scr、白蛋白等,计算Kt／V,并行心电图检查。以第 1次取血时间为研究的开始,记录随访期间患者的死亡情况及发生的心脑血管事件。结果 106 例MHD患者中,血清cTnT阳性28例(26．42％),血清CRP阳性32例(30．19％),2者均阳性16 例(15．09％)。平均随访(16．59±9．44)月,随访期间死亡22例(20．75％),发生心脑血管事件38 例(35．85％)。Logistic回归分析显示血清cTdT水平与CRP及Scr显著相关;血清CRP水平与年龄、cTnT及Kt／V显著相关。血清cTnT阳性组的病死率和心脑血管事件发生率比阴性组显著上升,P值分别为0．001和0．023。血清CRP阳性组与阴性组也表现同样结果。2者均阳性组与其他3组相比,病死率和心脑血管事件发生率也显著上升。生存分析显示,2者的单独阳性和联合阳性都对生存有明显影响。结论维持性血液透析无急性冠脉综合征的患者中,部分患者血清 cTnT水平升高。血清cTnT阳性与血清CRP及Scr水平相关。血清cTnT及CRP阳性组总病死率及心脑血管事件发生率均明显高于2者的阴性组。

Assessment of serum cardiac troponin T and C-reactive protein in predicting hemodialysis outcome

Objective To investigate serum cardiac troponin T(cTnT) and C-reactive protein (CRP) levels and assess the prognostic values of cTnT and CRP of mortality and cardiovascular events in maintenance hemodialysis (MHD) patients. Methods One hundred and six MHD patients were enrolled in this study. Serum cTnT, CRP, creatinine, albumin were measured in pre-hemodialysis at the beginning of the study. The mortality and cardiovascular events were recorded during the period of follow up. Results At the initiation of the study,28 patients (26.42%) were recorded with positive cTnT level, 32(30.19%) with positive CRP and 16 (15.09%) with positive cTnT and CRP. Logistic regression analysis showed a significant correlation between serum cTnT and serum CRP and Scr. Patients with positive cTnT and CRP levels had higher mortality and more cardiovascular events than those with negative levels. Kaplan-Meier survival analysis showed a significant difference between patients with normal and abnormal cTnT and CRP levels. Conclusions Some MHD patients have elevated serum cTnT level. Serum cTnT level is correlated with serum CRP and creatinine level. Patients with positive cTnT and CRP levels have higher mortality and more cardiovascular events than those with negative levels.