河北医科大学学报 ›› 2021, Vol. 42 ›› Issue (1): 12-16.doi: 10.3969/j.issn.1007-3205.2021.01.003

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高敏肌钙蛋白T对慢性肾衰竭非透析患者急性心肌梗死的诊断价值

  

  1. 1.河北省保定市第一中心医院心血管内科，河北 保定 071000；2.河北省保定市第一中心医院眼科，河北 保定 071000
  • 出版日期:2021-01-25 发布日期:2021-02-04
  • 作者简介:李欣悦(1994-)，女，黑龙江海伦人，河北省保定市第一中心医院医师，医学硕士研究生，从事心血管内科疾病诊治研究。
  • 基金资助:
    河北省中医药管理局科研计划（2018432）

Diagnostic value of high-sensitive cardiac troponin T in acute myocardial infarctionin patients with chronic renal failure

  1. 1.Department of Cardiology, the First Central Hospital of Baoding，  Hebei Province， Baoding 
    071000, China; 2.Depatment of Ophthalmology, the First Central Hospital of Baoding, 
    Hebei Province，Baoding 071000, China
  • Online:2021-01-25 Published:2021-02-04

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摘要： 目的  探讨高敏肌钙蛋白T(high-sensitive cardiac troponin T,hs-cTnT)对慢性肾衰竭（chronic renal failure,CRF）非透析患者急性心肌梗死（acute myocardial infarction,AMI）的诊断价值。
方法  选取慢性肾脏病4期(chronic kidney disease stage 4,CKD stage 4)非透析合并AMI患者52例（A组），单纯CKD4期非透析患者52例（B组）,比较2组患者入院时血清hs-cTnT水平，探讨其对CKD4期非透析患者AMI的最佳诊断值。
结果  A组患者血清hs-cTnT水平显著高于B组（P＜0.05）；左心房内径（left atriumdimension,LAD）、左心室舒张末期内径(left ventricular enddiastolic dimension,LVEDD)、左心室收缩末期内径(left ventricular endsystolic dimension,LVESD)与 hs-cTnT成正相关（P＜0.01）;左心室射血分数(left ventricularejection fraction,LVEF)及肾小球滤过率（glomerular filtration rate,eGFR）与hs-cTnT均成负相关；LVEDD、LVEF及eGFR是血清hs-cTnT浓度的独立影响因素；以72.50 ng/L为临界值,血清hs-cTnT诊断CRF非透析合并AMI的敏感度为75.00%，特异度为90.38%。
结论  对于CRF非透析患者，相应提高血清hs-cTnT的截断值，可有效提高诊断AMI的特异性。


关键词: 肾功能不全, 心肌梗死, 肌钙蛋白T

Abstract: Objective  To investigate the diagnostic value of high-sensitive cardiac troponin T(hs-cTnT) in acutemyocardial infarction(AMI)in chronic renal failure(CRF) patients without dialysis. 
Methods  A total of 52 patients with chronic kidney disease stage 4(CKD stage 4)and without dialysis complicated with AMI(Group A) and 52 patients with CKD stage 4 and without dialysis(Group B) were enrolled in this study. The levels of hs-cTnT in the serum of the two groups at admission were compared, and the optimal diagnostic value for AMI in CKD stage 1 patients without dialysis was discussed. 
Results  The level of hs-cTnT was significantly higher in group A than in group B(P＜0.05). hs-cTnT was positively correlated with left atrium dimension(LAD),left ventricular end diastolic dimension(LVEDD)and left ventricular end systolic dimension(LVESD)(P＜0.01). In addition, hs-cTnT was negatively correlated with left ventricular ejection fraction(LVEF）and glomerular filtration rate(eGFR). LVEDD,LVEF and eGFR were the independent influencing factors of hs-cTnT level.The sensitivity and specificity of hs-cTnT in the diagnosis of AMI in CRF patients without dialysis was 75.00% and 90.38% respectively, with 72.50 ng/L as the cut-off value. 
Conclusion  For CRF patients without dialysis, increasing hs-cTnT cut-off value can effectively improve the specificity in AMI diagnosis. 


Key words: renal insufficiency, myocardial infarction, troponin T

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