摘要
目的评价肌钙蛋白(cTn)在慢性肾脏病(CKD)患者中诊断急性心肌梗死(AMI)的表现,并探索提高诊断准确性的方法。方法回顾性纳入2018年1月~2020年12月南方医科大学珠江医院高危胸痛患者;根据肾功能水平分为CKD+组126例、CKD-组272例,根据最终诊断结果分为AMI+组122例、AMI-组276例。通过病历系统收集各组患者临床基线情况及相关血液化验结果,所有化验均要求在入院12 h内完成。结果在未发生AMI的患者中,CKD+组cTnT较CKD-组升高(P<0.001),且cTnT与eGFR存在中等强度的负相关关系(rs=-0.501,P<0.001);但cTnI在两组中无统计学差异(P=0.72)。在CKD患者中,cTnT诊断AMI的最佳界值为0.177μg/L,cTnI为0.415 ng/mL;cTnI诊断特异度较cTnT更高。cTnT与cTnI联合诊断模型为P=e^(Y)/(1+e^(Y)),Y=6.928(cTnT)-0.5(c TnI)-1.491,其AUC值高于单个c Tn。结论CKD患者的cTn诊断界值较普通患者升高;cTnI的诊断特异度较cTnT更高;联合应用cTnT与cTnI可能有助于进一步提高诊断效能。
Objective To evaluate the accuracy of cardiac troponin(cTn)levels in the diagnosis of acute myocardial infarction(AMI)in patients with chronic kidney disease(CKD)and explore a potential strategy for improving the diagnostic accuracy.Methods We retrospectively analyzed the data from patients with high-risk chest pain admitted in Zhujiang Hospital from January,2018 to December,2020,including 126 patients with and 272 patients without CKD,and 122 patients diagnosed to have AMI and 276 patients without AMI.The baseline clinical data of the patients and blood test results within 12 h after admission were collected.Results In patients without AMI,cTnT level was significantly higher in those with co-morbid CKD than in those without CKD(P<0.001),and showed a moderate negative correlation with eGFR(rs=-0.501,P<0.001),while cTnI level did not differ significantly between the two groups(P=0.72).In patients with CKD,the optimal cutoff level was 0.177μg/L for cTnT and 0.415 ng/mL for cTnI for diagnosis of AMI,for which c TnI had a higher specificity than c TnT.The diagnostic model combining both cTnT and cTnI levels[P=e^(Y)/(1+e^(Y)),Y=6.928(cTnT)-0.5(cTnI)-1.491]had a higher AUC value than c Tn level alone.Conclusion In CKD patients,the cutoff level of cTn is increased for diagnosing AMI,and c TnI has a higher diagnostic specificity than cTnT.The combination of cTnT and cTnI levels may further improve diagnostic efficacy for AMI.
作者
邓钰莹
陈华锋
李功辉
陈立桁
傅强
DENG Yuying;CHEN Huafeng;LI Gonghui;CHEN Liheng;FU Qiang(Department of Cardiovascular Disease,Zhujiang Hospital,Southern Medical University,Guangzhou 510280,China;Department of Endocrinology and Metabolism,Zhujiang Hospital,Southern Medical University,Guangzhou 510280,China;Department of Cardiovascular Disease,Shenzhen Hospital,Southern Medical University,Shenzhen 518101,China)
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2023年第2期300-307,共8页
Journal of Southern Medical University
基金
广东省中医药局科研项目(202122154)。
