糖尿病肾脏疾病透析患者肌钙蛋白T水平的变异及临床价值分析

    Variability and clinical value of troponin T levels in diabetic kidney disease patients treated with dialysis

    • 摘要: 目的 明确肌钙蛋白T(troponin T,TnT)在糖尿病肾脏疾病(diabetic kidney disease,DKD)透析患者中的变异情况,评价TnT对DKD透析患者的临床价值。方法 对2014年1月1日至2020年8月31日山东省济南市中心医院8553例透析患者及其TnT值进行筛选,依据患者的纳入与排除标准筛除5692例,排除不符合TnT入选标准者2485例,最后入选376例患者。入选患者根据原发疾病分为DKD透析组和非糖尿病肾脏疾病(non-diabetic kidney disease,NDKD)透析组,比较2组患者TnT基线水平的差异,并采用受试者工作特征曲线确立诊断急性心肌梗死的最佳阈值,进一步分析DKD透析患者TnT基线的影响因素及与预后不良的关系。结果 DKD透析组患者TnT基线水平(267.27 ng/L)明显高于NDKD透析组患者(76.09 ng/L),是NDKD透析组的3.51倍;NDKD透析组患者诊断急性心肌梗死的最佳阈值为166.85 ng/L,DKD透析组患者的最佳阈值为367.45 ng/L;DKD透析组中男性的TnT基线水平高于女性,TnT基线水平与年龄、糖尿病视网膜病变程度、下肢血管病变程度呈正相关,与血红蛋白、白蛋白呈负相关。随着TnT基线水平逐级递增,DKD透析组患者心肌梗死率、心因性病死率、糖尿病足部溃疡率、全因死亡率也逐级升高。结论 DKD透析组患者的TnT基线水平明显高于NDKD透析组患者,且诊断急性心肌梗死时需要更高的阈值。TnT基线水平升高受糖尿病血管并发症等因素影响,可作为不良事件的预后指标。

       

      Abstract: Objective To determine the variation of troponin T(TnT)in diabetic kidney disease(DKD)patients treated with dialysis,and to evaluate its clinical value. Methods A total of 8,553 DKD patients treated with dialysis and examination of TnT values were screened in Jinan Central Hospital from January 1,2014 to August 31,2020. Screened by inclusion and exclusion criteria,5,692 patients were excluded. After excluding 2,485 cases with unavailable TnT data,finally,376 eligible patients were included into our study. They were divided into DKD dialysis group and non-DKD(NDKD) dialysis group based on the primary disease. Baseline TnT was compared between the two groups,and the optimal threshold to diagnose acute myocardial infarction was determined by plotting the receiver operating characteristic(ROC)curves. Influencing factors for baseline TnT in DKD patients treated with dialysis and their correlation with poor prognosis were analyzed. Results Baseline TnT in the DKD dialysis group(267. 27 ng/L)was significantly higher than that in the NDKD dialysis group(76. 09 ng/L),which was 3. 51 times higher. The optimal threshold of baseline TnT for the diagnosis of acute myocardial infarction was 166. 85 ng/L in NDKD dialysis group,and 367. 45 ng/L in DKD group. Higher baseline TnT were detected in men than women in the DKD dialysis group. Baseline TnT was positively associated with age,degree of DKD,and degree of lower extremity vasculopathy,but negatively correlated with hemoglobin and albumin. With the increase in baseline TnT,the rate of myocardial infarction, psychogenic mortality,diabetic foot ulcer,and all-cause mortality increased in DKD dialysis group. Conclusion Baseline TnT is significantly higher in the DKD dialysis group than that of the NDKD dialysis group,and a higher threshold is required for the diagnosis of acute myocardial infarction. Elevated baseline TnT level is influenced by factors such as diabetic vascular complications,which can be used as a prognostic indicator for adverse events.

       

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