老年血液透析患者血清高敏肌钙蛋白I与左心室结构及功能关系的探讨  

Relationship of serum high-sensitivity cardiac troponin I with left ventricular structure and function in elderly patients undergoing hemodialysis

作　　者：吕路[1] 蒋文功[1] 高敏 管红斌[1] 黄华[1] Lv Lu;Jiang Wengong;Gao Min;Guan Hongbin;Huang Hua(Department of Nephrology,First Hospital,Guangdong Pharmaceutical University,Guangzhou 510080,China)

机构地区：[1]广东药科大学附属第一医院肾内科,广州510080

出　　处：《国际医药卫生导报》2019年第14期2214-2217,共4页International Medicine and Health Guidance News

基　　金：广东省科技计划(2016ZC0169).

摘　　要：目的了解老年血液透析患者血清高敏肌钙蛋白I(hs-cTnI)与左心室结构、功能的关系。方法 选择2015年1月至2018年6月期间在本院血透中心接受维持性血液透析的老年患者,符合入选条件的患者有92名,收集患者的临床资料,用彩色多普勒超声心动图检测心脏结构和功能。结果 hscTnI升高组有32例患者,hs-cTnI正常组有60例患者。hs-cTnI升高组的心功能III-IV级(78.12%比21.67%)和左心室肥厚(LVH)的患者比例(87.50%比63.33%)显著高于hs-cTnI正常组(P<0.05)。两组的血红蛋白、血清白蛋白、脑钠肽(BNP)和高敏C反应蛋白(hsCRP)比较差异有统计学意义(P<0.05)。hs-cTnI升高组的左心室内径(LVD)、左心室质量指数(LVMI)和二尖瓣舒张早期血流峰值和二尖瓣环舒张早期运动速度之比(E/E’)显著大于hs-cTnI正常组(P<0.05),hs-cTnI升高组的缩短分数(FS)和左心室射血分数(EF)显著小于hs-cTnI正常组(P<0.05)。hs-cTnI与hsCRP、BNP、LVD、LVMI、E/E’呈显著正相关,hs-cTnI与血清白蛋白、EF、FS呈显著负相关。多自变量Logistic回归显示,年龄、血红蛋白、LVMI和E/E’是hs-cTnI升高的显著影响因素(P<0.05)。hs-cTnI诊断LVH、左心室收缩功能不全和左心室舒张功能不全的ROC曲线的曲线下面积分别是0.697、0.884和0.917。结论老年血液透析患者的血清hs-cTnI水平与左心室结构、功能有关,测量血清hs-cTnI有助于评估老年血液透析患者的LVH、左心室收缩与舒张功能。Objective To investigate the relationship of serum high-sensitivity cardiac troponin I (hscTnI) with left ventricular structure and function in elderly hemodialysis patients. Methods 92 elderly patients undergoing maintenance hemodialysis at our hemodialysis center were selected between January, 2015 and June, 2018. Their clinical data were collected. Their cardiac structure and function were measured by echocardiography. Results The serum hs-cTnI increased in 32 patients, and was normal in 60 patients. The proportions of the patients with III- IV grade cardiac function and left ventricular hypertrophy (LVH)were significantly higher in the elevated hs-cTnI group than in the normal hs-cTnI group (78.12% vs. 21.67% and 87.50% vs. 63.33%, both P < 0.05). There were statistical differences in hemoglobin, serum albumin, brain natriuretic peptide (BNP), and high sensitivity C reactive protein (hsCRP) between the two groups. Compared to the normal hs-cTnI group, the elevated hs-cTnI group had significantly larger left ventricular diameter (LVD), left ventricular mass index (LVMI) and the ratio of mitral early diastolic peak flow and mitral annular early diastolic velocity (E/E’)(all P < 0.05). The fractional shortening (FS) and left ventricular ejection fraction (EF) in the elevated hs-cTnI group were significantly lower than those in the normal hs-cTnI group (P < 0.05). Hs-cTnI positively correlated with hsCRP, BNP, LVD, LVMI, and E/E', and negatively with serum albumin, EF, and FS. Age, hemoglobin, LVMI, and E/E' were significant indicators of high hs-cTnI level in the multivariate logistic regression. The areas under the ROC curve for the diagnosis of LVH, left ventricular systolic insufficiency, and left ventricular diastolic dysfunction by hs-cTn I were 0.697, 0.884, and 0.917, respectively. Conclusions The serum hs-cTnI level of elderly patients undergoing hemodialysis relates to their left ventricular structure and function. Measurement of serum hs-cTnI is helpful to evaluate LVH and left ventricular systolic a

关 键 词：高敏肌钙蛋白I 左心室 血液透析 心功能衰竭 

分 类 号：R692.5[医药卫生—泌尿科学] R540.45[医药卫生—外科学]