维持性血液透析患者血清心肌肌钙蛋白T、hs- CRP表达与心血管并发症的关系研究  

The Relationship Between Expressions of Serum Cardiac Troponin T andhs-CRP and Cardiovascular Complications in Patientswith Maintenance Hemodialysis

作　　者：谢嘉平 张波 尧鹏 曾莉 卿山林 XIE Jiaping;ZHANG Bo;YAO Peng;ZENG Li;QING Shanlin(Department of Nephrology,The Second Affiliated Hospital of ChengduMedical College,416 Hospital of Nuclear Industry,Chengdu 610051,China;Department of Nuclear Medicine,The Second Affiliated Hospital of ChengduMedical College,416 Hospital of Nuclear Industry,Chengdu 610051,China)

机构地区：[1]成都医学院第二附属医院·核工业四一六医院肾内科,四川成都610051 [2]成都医学院第二附属医院·核工业四一六医院核医学科,四川成都610051

出　　处：《标记免疫分析与临床》2023年第6期942-947,977,共7页Labeled Immunoassays and Clinical Medicine

基　　金：成都市金牛区肾脏内科专委会课题(编号:JNQN)。

摘　　要：目的探究维持性血液透析(MHD)患者血清心肌肌钙蛋白T(cTnT)、超敏C反应蛋白(hs-CRP)表达与心血管并发症的关系。方法回顾性分析我院2020年3月至2021年12月间219例行维持性血液透析(MHD)治疗的终末期肾脏疾病患者资料,根据是否发生心血管并发症分为无心血管并发症组(n=123)和心血管并发症组(n=96),采用电化学发光法检测患者血清cTnT水平,采用免疫透射比浊法测定法检测血清hs-CRP水平,比较两组一般临床资料及血清cTnT、hs-CRP水平,采用多元Logistic回归分析探究影响MHD患者心血管事件发生的危险因素,Pearson相关性分析法分析cTnT、hs-CRP与心血管发生的相关性,ROC曲线分析血清cTnT、hs-CRP对MHD患者心血管并发症的预测价值。结果心血管并发症组60岁以上占比、透析龄、透析次数、高血压占比、血清BUN、Alb、Cr、CysC、Hcy、NT-proBNP、TG、TC、cTnT、hs-CRP水平均显著高于无心血管并发症组,HDL-C水平显著低于无心血管并发症组(P<0.05),两组性别、BMI、吸烟占比、饮酒占比、血尿酸、血红蛋白、LDL-C水平比较,差异无统计学意义(P>0.05);多因素Logistic回归分析显示,年龄、透析龄、透析次数、合并高血压、血清NT-proBNP、cTnT、hs-CRP水平是影响MHD患者心血管事件发生的危险因素,血清HDL-C水平是保护因素(P<0.05);Pearson相关性分析显示,血清cTnT、hs-CRP水平与心功能指标LVEF均呈负相关,与LVMI均呈正相关(P<0.05),其中cTnT与LVEF、LVMI呈中度相关,hs-CRP与LVEF、LVMI呈低度相关;ROC曲线显示,血清cTnT、hs-CRP单独及联合诊断MHD患者心血管并发症的AUC分别为0.892、0.751、0.945,灵敏度为76.98%、71.88%、83.33%,特异性为94.48%、83.74%、95.12%,联合诊断价值更高。结论MHD患者血清cTnT、hs-CRP表达与心血管并发症发生呈显著相关性,对不良心血管事件具有较高的预测价值。Objective To explore the relationship between expressions of serum cardiac troponin T(cTnT)and hypersensitive C-reactive protein(hs-CRP)and cardiovascular complications in patients undergoing maintenance hemodialysis(MHD).Methods The clinical data of 219 patients with end-stage renal disease who underwent MHD in the hospital from March,2020 to December,2021 were retrospectively analyzed.According to the presence or absence of cardiovascular complications,these patients were divided into the non-cardiovascular complication group(n=123)and cardiovascular complication group(n=96).Serum cTnT concentration was detected by electrochemiluminescence method,and serum hs-CRP concentration was detected by immunity transmission turbidity.The general clinical data and serum levels of cTnT and hs-CRP were compared between the two groups.Multivariate logistic regression analysis was applied to explore the risk factors affecting the occurrence of cardiovascular events in patients with MHD.Pearson correlation analysis was used to analyze the correlation between cTnT,hs-CRP and cardiovascular events.ROC curve was drawn to evaluate the predictive value of serum cTnT and hs-CRP on cardiovascular complications in patients with MHD.Results The proportion of patients over 60 years old,dialysis age,dialysis frequency,proportion of hypertension and levels of serum BUN,Alb,Cr,CysC,Hcy,NT-proBNP,TG,TC,cTnT and hs-CRP in cardiovascular complication group were significantly higher than those in the non-cardiovascular complication group,while HDL-C level was significantly lower than that in the non-cardiovascular complication group(P<0.05).There were no statistically significant differences in gender,BMI,proportion of smoking,proportion of drinking,blood uric acid,hemoglobin and LDL-C between the two groups(P>0.05).Multivariate logistic regression analysis showed that age,dialysis time,dialysis frequency,hypertension,serum NT-proBNP,cTnT and hs-CRP were risk factors for cardiovascular events in patients with MHD,while serum HDL-C level was a

关 键 词：维持性血液透析 尿毒症 心肌肌钙蛋白T C反应蛋白 危险因素 诊断价值 

分 类 号：R459.5[医药卫生—治疗学]