心肌生物学标志物联合检测对血液透析患者心血管原因死亡风险的预测价值  

Prognostic efficacy of combined index of cardiac biomarkers for cardiovascular and all-cause mortality on hemodialysis patients

作　　者：张丽红[1] 崔锐[1] 杨涛[1] 詹申 任树风[1] 王玉柱[1] 

机构地区：[1]北京市海淀医院北京大学第三医院海淀院区肾内科,100080

出　　处：《中华肾脏病杂志》2015年第3期173-178,共6页Chinese Journal of Nephrology

基　　金：北京市海淀区科技项目（K20110068）

摘　　要：目的 前瞻性研究维持性血液透析（MHD）患者血清氨基末端脑钠肽前体（NT-proBNP）、肌钙蛋白T（TnT）及高敏C反应蛋白（HsCRP）水平与心血管原因死亡及预后的关系.方法 选取北京市海淀区3个透析中心接受透析治疗时间＞3月的MHD患者229例为研究对象.电化学发光法检测受试者血清NT-proBNP、TnT及HsCRP水平,记录患者临床资料.随访患者因心血管原因死亡、全因死亡的时间,随访时间为1000d.Kaplan-Meier生存分析法计算患者生存率;Cox比例风险模型法分析NT-proBNP、TnT、HsCRP及3者联合检测对患者心血管原因死亡和全因死亡风险的预测价值.结果 随访期间共37例患者死亡,其中因心血管疾病死亡20例（54.05％）.单因素分析结果显示,HsCRP≥3 mg/L、TnT≥0.1 mg/L、NT-proBNP≥4 381 ng/L、年龄＞60岁、合并糖尿病、心脑血管疾病、低血清白蛋白（Alb）与全因死亡事件发生有相关性.Cox分析结果显示,血清NT-proBNP、TnT、HsCRP升高与患者心血管疾病死亡及全因死亡事件发生相关,联合3项指标检测均升高者心血管疾病死亡风险（HR=25.25,P＜0.01）和全因死亡事件风险（HR=27.33,P＜0.01）明显升高.经年龄、心脑血管疾病史、糖尿病、白蛋白等校正后,上述指标均升高者对心血管疾病死亡（HR=14.33,P＜0.01）及全因死亡事件发生有较强的预测价值（HR=11.54,P＜0.01）.结论 心肌生物学标志物联合检测有助于预测MHD患者心血管疾病死亡及全因死亡事件风险分层,MHD患者应定期常规检测相关指标.Objective To evaluate cardiac biomarkers as biological risk factors for cardiovascular and all-cause motality in HD patients.In addition,a multimarker approach including inflammatory index was performed to improve the cardiovascular and all-canse risk assessment of these patients.Methods The author measured Troponin-T （TnT）,N-terminal pro brain natriuretic peptide （NT-proBNP） and high-sensitivity C-reactive protein （HsCRP）,collected the clinical data at baseline （January 2012） in 229 HD patients in three hemodialysis centers in Haidian District of Beijing,recorded time and cause of death in the next 1000 days.Kaplan-Meier was used to calculate survival rate and impact factors of prognosis.Cox proportional hazard model was used to estimate significance of =TnT,NT-proBNP and HsCRP and adjusted hazard ratios （HRs） of death.Results During the followup,37 patients died,mainly from cardiac cause （54.05％,20/37）.Univariate analysis found old age,diabetes,cardiovascular disease,low serum albumin,CRP≥3 mg/L,TnT≥0.1 mg/L,NT-proBNP≥ 4381 ng/L were associated with prognosis.Elevated cTnT,NT-proBNP or HsCRP were all associated with increased cardiovascular and all-cause motality.Moreover,the combination of all parameters （NTproBNP≥4381 ng/L and TnT≥0.1 mg/L and HsCRP≥3 mg/L） were dramatically associated with increased cardiovascular cause mortality （HR=25.25,P ＜ 0.01） and all-cause mortality （HR=27.33,P ＜ 0.01）.The association were significant even after full adjustment for cardiovascular （HR=14.33,P ＜ 0.01） and all-cause mortality （HR=1 1.54,P ＜ 0.01） respectively.Conclusions A combined index of cardiovascular risk factors could provide supplementary risk stratification in HD patients for cardiovascular mortality and all-cause mortality,strongly supporting the annual routine determination of these biomarkers.

关 键 词：肾透析 心血管疾病 生物学标记物 心肌 死亡率 

分 类 号：R459.5[医药卫生—治疗学]