南方医科大学学报

南方医科大学学报 ›› 2023, Vol. 43 ›› Issue (2): 300-307.doi: 10.12122/j.issn.1673-4254.2023.02.20

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慢性肾脏病对肌钙蛋白诊断急性心肌梗死准确性的影响

邓钰莹，陈华锋，李功辉，陈立桁，傅 强   

  1. 南方医科大学珠江医院心血管内科，珠江医院内分泌代谢科，广东 广州 510282；深圳医院心血管内科，广东 深圳 518101
  • 出版日期:2023-02-20 发布日期:2023-03-16

Effect of co-morbid chronic kidney disease on the accuracy of cardiac troponin levels for diagnosis of acute myocardial infarction

DENG Yuying, CHEN Huafeng, LI Gonghui, CHEN Liheng, FU Qiang   

  1. Department of Cardiovascular Disease, Department of Endocrinology and Metabolism, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China; Department of Cardiovascular Disease, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, China
  • Online:2023-02-20 Published:2023-03-16

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摘要： 目的 评价肌钙蛋白（cTn）在慢性肾脏病（CKD）患者中诊断急性心肌梗死（AMI）的表现，并探索提高诊断准确性的方法。方法 回顾性纳入 2018年1月~2020年12月南方医科大学珠江医院高危胸痛患者；根据肾功能水平分为CKD+组126例、CKD-组272例，根据最终诊断结果分为AMI+组122例、AMI-组276例。通过病历系统收集各组患者临床基线情况及相关血液化验结果，所有化验均要求在入院12 h内完成。结果 在未发生AMI的患者中，CKD+组cTnT较CKD-组升高（P<0.001），且cTnT与eGFR存在中等强度的负相关关系（rs=-0.501，P<0.001）；但cTnI在两组中无统计学差异（P=0.72）。在CKD患者中，cTnT诊断AMI的最佳界值为0.177 μg/L，cTnI为0.415 ng/mL；cTnI诊断特异度较cTnT更高。cTnT与cTnI联合诊断模型为P=eY（/1+eY），Y=6.928（cTnT）-0.5（cTnI）-1.491，其AUC值高于单个cTn。结论 CKD患者的cTn诊断界值较普通患者升高；cTnI的诊断特异度较cTnT更高；联合应用cTnT与cTnI可能有助于进一步提高诊断效能。

关键词: 急性心肌梗死；慢性肾脏病；肌钙蛋白T；肌钙蛋白I

Abstract: Objective To evaluate the accuracy of cardiac troponin (cTn) levels in the diagnosis of acute myocardial infarction (AMI) in patients with chronic kidney disease (CKD) and explore a potential strategy for improving the diagnostic accuracy. Methods We retrospectively analyzed the data from patients with high- risk chest pain admitted in Zhujiang Hospital from January, 2018 to December, 2020, including 126 patients with and 272 patients without CKD, and 122 patients diagnosed to have AMI and 276 patients without AMI. The baseline clinical data of the patients and blood test results within 12 h after admission were collected. Results In patients without AMI, cTnT level was significantly higher in those with co-morbid CKD than in those without CKD (P<0.001), and showed a moderate negative correlation with eGFR (rs=? 0.501, P<0.001), while cTnI level did not differ significantly between the two groups (P=0.72). In patients with CKD, the optimal cutoff level was 0.177 μg/L for cTnT and 0.415 ng/mL for cTnI for diagnosis of AMI, for which cTnI had a higher specificity than cTnT. The diagnostic model combining both cTnT and cTnI levels [P=eY/(1+eY), Y=6.928 (cTnT)-0.5 (cTnI)-1.491] had a higher AUC value than cTn level alone. Conclusion In CKD patients, the cutoff level of cTn is increased for diagnosing AMI, and cTnI has a higher diagnostic specificity than cTnT. The combination of cTnT and cTnI levels may further improve diagnostic efficacy for AMI.

Key words: acute myocardial infarction; chronic kidney disease; troponin T; troponin I