慢性肾脏病非透析患者血hs-cTnT、NT-proBNP、CK-MB评估心脏结构功能的临床价值比较
发布时间：2018-09-01 09:08
【摘要】：[目的]比较慢性肾脏病(chronic kidney disease, CKD)非透析患者血高敏心肌肌钙蛋白T(hs-cTnT)、N末端B型利钠肽原(NT-proBNP)、肌酸激酶同工酶(CK-MB)指标水平在不同CKD分期的变化情况,以及比较三者在诊断心脏结构功能的ROC曲线面积的准确性,为进一步寻找预测慢性肾脏病(CKD)非透析患者心脏结构功能较为准确的心肌损伤标志物提供临床依据,以便为早期发现慢性肾脏病非透析患者心血管疾病提供一定价值。[方法]入选标准为昆明医科大学第二附属医院肾脏内科2015年1月-2017年1月慢性肾脏病非透析住院患者共137例,收集含有hs-cTnT、NT-proBNP、CK-MB指标的检测资料,纳入研究变量包括人口学及人体测量资料(性别、年龄、体重、血压等)、纳入肾脏原发疾病(原发慢性肾小球肾炎、高血压肾损害、狼疮性肾炎、梗阻性肾病、ANCA相关性肾炎等)。纳入实验室检查指标包括高敏心肌肌钙蛋白T(hs-cTnT)、N末端B型利钠肽原(NT-proBNP)、肌酸激酶同工酶(CK-MB)、总胆固醇(TC)、甘油三酯(TG)、血清高密度脂蛋白(HDL)、血清低密度脂蛋白(LDL)、血红蛋白(Hb)、血肌酐(Scr)、血尿素氮(BUN)以及纳入心脏超声检查指标等。选取同期到昆明医科大学第二附属医院进行健康体检人员29例,作为对照组。采用spss19.0进行数据分析,计量资料符合正态分布采用均数标准差进行表示,两样本间比较采用t检验,三个及以上样本间比较采用单因素方差分析;计数资料采用率进行表示,采用卡方分析进行差异性检验,绘制ROC曲线对指标的诊断效能进行评价,由ROC曲线下面积综合评价诊断准确性,以p0. 05表示有统计学意义。[结果]经统计学分析不同CKD分组的病例组患者与健康对照组比较,在性别、年龄、BMI、TC、TG、HDL及LDL指标差异无统计学意义(P0.05);在SP、DP、BUN、SCr指标上高于对照组,差异具有统计意义(p0.001),Hb、eGFR低于对照组,差异具有统计学意义(p0. 001)。CKD各组间比较:CKD5组与CKD3-4组患者Hb、eGFR指标较CKD1-2组降低,差异有统计意义(p0.001),SP、DP、BUN、SCr指标较CKD1-2组升高,差异有统计意义(p0. 001)。经统计学分析,CKD1-2组血浆hs-cTnT、NT-proBNP、CK-MB指标水平与对照组比较指标差异无统计学意义,CKD3-4组与CKD5组血浆hs-cTnT、NT-proBNP、CK-MB指标水平升高,与对照组比较差异有统计学意义(p0.001),而CKD各组间比较:hs-cTnT在CKD3-4组与CKD1-2组之间比较差异有统计学意义(p0. 001), hs-cTnT在CKD5 组(0.2308±0. 1329)明显高于 CKD1-2 组(0.0071 ±0.00641 )、CKD3-4组(0. 0324±0. 02664),差异有统计学意义(p0. 001 )。CK-MB 在 CKD3-4 组与CKDD1-2组之间比较差异无统计学意义,CKD5组(4.31±2.461)明显高于CKD1-2组(1.66±1.475)、CKD3-4 组(2.31±1.554),差异有统计学意义(p0.001)。NT-proBNP在CKD3-4组与CKD1-2之间比较差异无统计学意义,在CKD5组(1054.21±241.70)明显高于CKD1-2组(84.25±37.728)、CKD3-4组(475.08±388.761),差异有统计学意义(p0. 001)。CKD各组间比较:血hs-cTnT阳性率在CKD3-4组较CKD1-2组升高,差异具有统计学意义(p0. 001 ),CKD5组阳性率(56.7%),明显高于CKD1-2组(5.7%)、CKD3-4组(28.6%),差异有统计学意义(p0.001)。NT-ProBNP阳性率在CKD3-4组与CKD1-2组之间比较,差异具有统计学意义(p0. 001 ),CKD5组阳性率(53. 3%)明显高于CKD1-2组(0%)、CKD3-4组(11. 9%),差异有统计学意义(p0. 001 )。血清CK-MB阳性率在CKD3-4组与CKD1-2组之间比较,差异无统计学意义,CKD5组阳性率(30%)明显高于CKD1-2组(2.8%)、CKD3-4组(4.7%),差异有统计学意义(p0.001)。不同CKD分期的患者在左室收缩功能不全指标(EF50%)指标上差异无统计学意义(p0. 05); CKD 各组间比较:CKD3-4 期组患者,LvDd、IVST、LAD、LVMI、E/A1、LVH指标较CKD1-2期升高,差异具有统计学意义(p0.001),LVEF指标下降,差异具有统计学意义(p0.001),CKD5组患者LvDd、IVST、LVPWT、LVMI指标较CKD3-4组升高,差异具有统计学意义(p0.001),LVEF指标下降,差异具有统计学意义(p0.001),CKD5 组患者 LvDd、IVST、LVPWT、LVMI、E/A1、LVH指标较CKD1-2组升高,差异具有统计学意义(p0.001),LVEF指标下降,差异具有统计学意义(p0. 001)。经统计学分析伴有左心室肥厚CKD患者血浆hs-cTnT、NT-proBNP、CK-MB水平较无左心室肥厚、正常对照组显著升高(p0.001),无左心室肥厚组hs-cTnT、NT-proBNP、CK-MB水平较正常对照组升高(p0. 001),伴有左室舒张功能不全的CKD患者血浆hs-cTnT、NT-proBNP、CK-MB水平较无左室舒张功能不全、正常对照组显著升高(p0. 001),无左心室舒张功能不全组hs-cTnT、NT-proBNP、CK-MB水平较正常对照组升高(p0.001)。CKD患者血浆hs-cTnT、NT-proBNP、CK-MB水平,绘制受试者工作特征曲线评估左室肥厚。经R0C曲线分析得,CK-MB预测概率:AUC=(0.818± 0.035 )(95%CI:0.749-0.887,p0.001),CK-MB评估左室肥厚准确率最高,其次NT-proBNP,hs-cTnT。根据 CKD 患者血浆 hs-cTnT、NT-proBNP、CK-MB 水平,绘制受试者工作特征曲线评估左室舒张功能。经ROC曲线分析得,CK-MB预测概率:AUC= (0.774±0. 048) (95%CI:0. 679-0.868, p0. 001),准确性最高是 CK-MB,其次 NT-proBNP, hs-cTnT。[结论]1. CKD非透析患者普遍存在心脏结构与功能的改变。2. CKD非透析患者血浆hs-cTnT、NT-proBNP、CK-MB水平普遍升高,并且随着肾功能恶化而进行性升高。3. CKD非透析患者血浆hs-cTnT、NT-proBNP、CK-MB水平与心脏结构功能密切相关,左室肥厚与左室舒张不全患者血hs-cTnT、NT-proBNP、CK-MB水平较无左室肥厚、无左室舒张功能不全及对照组显著升高。4. CKD非透析患者血浆hs-cTnT、NT-proBNP、CK-MB诊断左室肥厚与左室舒张功能不全的R0C曲线面积,CK-MB准确性最高。检测CK-MB可作为CKD早期心血管疾病的可靠指标之一。
[Abstract]:[Objective] To compare the changes of high-sensitivity cardiac troponin T (hs-cTnT), N-terminal B-type natriuretic peptide (NT-proBNP) and creatine kinase isoenzyme (CK-MB) in different CKD stages in non-dialysis patients with chronic kidney disease (CKD), and to compare the accuracy of the three parameters in diagnosing the ROC curve area of cardiac structure and function. To find more accurate markers of myocardial damage for predicting cardiac structure and function in non-dialysis patients with chronic kidney disease (CKD), so as to provide some value for early detection of cardiovascular disease in non-dialysis patients with chronic kidney disease. A total of 137 non-dialysis inpatients with chronic kidney disease in January 17 were enrolled in the study. The data of detection of hs-cTnT, NT-proBNP and CK-MB were collected. The included variables included demographic and anthropometric data (gender, age, weight, blood pressure, etc.) and included in the study were primary renal diseases (primary chronic glomerulonephritis, hypertensive nephropathy, lupus nephritis, obstructive nephropathy). Laboratory tests included high-sensitivity cardiac troponin T (hs-cTnT), N-terminal B-type natriuretic peptide (NT-proBNP), creatine kinase isoenzyme (CK-MB), total cholesterol (TC), triglyceride (TG), serum high-density lipoprotein (HDL), serum low-density lipoprotein (LDL), hemoglobin (Hb), serum creatinine (Scr), blood urea nitrogen (BUN). Twenty-nine health examinees from the Second Affiliated Hospital of Kunming Medical University were selected as the control group. Data were analyzed by SPSS 19.0. The measurement data accorded with normal distribution was expressed by mean standard deviation. The comparison between the two samples was performed by t-test and the ratio of three or more samples was compared. Compared with the single factor analysis of variance, the counting data were expressed by the rate, the difference was tested by chi-square analysis, and the diagnostic efficiency of the indexes was evaluated by drawing ROC curve. The diagnostic accuracy was evaluated by the area under the ROC curve, and the P0.05 was statistically significant. [Results] The patients with different CKD groups were statistically analyzed. Compared with the healthy control group, there was no significant difference in gender, age, BMI, TC, TG, HDL and LDL (P 0.05); SP, DP, BUN, SCr index was higher than the control group, the difference was statistically significant (p 0.001), Hb, eGFR was lower than the control group, the difference was statistically significant (p 0.001). CKD between the CKD 5 group and CKD 3-4 group Hb, eGFR index than CKD 1-2. The levels of plasma hs-cTnT, NT-proBNP, CK-MB in CKD1-2 group were higher than those in CKD1-2 group, and the levels of plasma hs-cTnT, NT-proBNP, CK-MB in CKD3-4 group and CKD5 group were higher than those in control group. There were significant differences between the control group (p0.001), and CKD groups: hs-cTnT in CKD 3-4 group and CKD 1-2 group were significantly different (p0.001). hs-cTnT in CKD 5 group (0.2308.1329) was significantly higher than CKD 1-2 group (0.0071.00641), CKD 3-4 group (0.0324.02664), the difference was statistically significant (p0.001). There was no significant difference between CKD3-4 group and CKDD1-2 group. CKD5 group (4.31+2.461) was significantly higher than CKD1-2 group (1.66+1.475) and CKD3-4 group (2.31+1.554), and the difference was statistically significant (p0.001). NT-proBNP had no significant difference between CKD3-4 group and CKD1-2 group, and CKD5 group (1054.21+241.70) was significantly higher than CKD1-2 group (84.25+37.70). The positive rate of hs-cTnT in CKD 3-4 group was higher than that in CKD 1-2 group, the difference was statistically significant (p0.001). The positive rate of CKD 5 group (56.7%) was significantly higher than that in CKD 1-2 group (5.7%) and CKD 3-4 group (28.6%). The positive rate of CKD5 group (53.3%) was significantly higher than CKD1-2 group (0%) and CKD3-4 group (11.9%). The difference was statistically significant (p0.001). The positive rate of serum CK-MB was significantly higher in CKD3-4 group than CKD1-2 group (30%). There was no significant difference in the index of left ventricular systolic dysfunction (EF50%) among the patients with different CKD stages (p0.05); CKD between the groups: CKD 3-4 group, LvDd, IVST, LAD, LVMI, E/A1, LVH index was higher than CKD 1-2 group, the difference was statistically significant (p0.001), LVEF index LvDd, IVST, LVPWT, LVMI in CKD5 group were higher than CKD3-4 group, the difference was statistically significant (p0.001), LVEF index decreased, the difference was statistically significant (p0.001), CKD5 group LvDd, IVST, LVPWT, LVMI, E/A1, LVH index was higher than CKD1-2 group, the difference was statistically significant (p0.001), LVEF index was significantly higher (p0.001). The levels of hs-cTnT, NT-proBNP, CK-MB in CKD patients with left ventricular hypertrophy were significantly higher than those without left ventricular hypertrophy (p0.001). The levels of hs-cTnT, NT-proBNP, CK-MB in CKD patients without left ventricular hypertrophy were significantly higher than those in CKD patients without left ventricular hypertrophy (p0.001). Plasma levels of hs-cTnT, NT-proBNP, CK-MB in patients with CKD were significantly higher than those without left ventricular diastolic dysfunction (p0.001). The levels of hs-cTnT, NT-proBNP and CK-MB in patients without left ventricular diastolic dysfunction were significantly higher than those in normal controls (p0.001). The levels of hs-cTnT, NT-proBNP, CK-MB in patients with CKD were significantly higher than those in normal controls (p0.001). Estimation of left ventricular hypertrophy by R0C curve analysis, CK-MB predictive probability: AUC = (0.818 + 0.035) (95% CI: 0.749-0.887, p0.001), CK-MB assessment of left ventricular hypertrophy the highest accuracy, followed by NT-proBNP, hs-cTnT. According to the plasma levels of hs-cTnT, NT-proBNP, CK-MB in patients with CKD, draw the subjects'working characteristic curve to assess left ventricular diastolic function. The predictive probability of CK-MB: AUC = 0.774 (+ 0.048) (95% CI: 0.679-0.868, p0.001), the highest accuracy was CK-MB, followed by NT-proBNP, hs-cTnT. [Conclusion] 1. The changes of cardiac structure and function were prevalent in non-dialysis patients with CKD. 2. The levels of hs-cTnT, NT-proBNP, CK-MB in non-dialysis patients with CKD generally increased, and progressed with the deterioration of renal function. The levels of hs-cTnT, NT-proBNP, CK-MB in non-dialysis patients were closely related to cardiac structure and function. Left ventricular hypertrophy and left ventricular diastolic insufficiency patients had higher levels of hs-cTnT, NT-proBNP, CK-MB than those without left ventricular hypertrophy, left ventricular diastolic dysfunction and control group. 4. The levels of hs-cTnT, NT-proBNP, CK-MB in non-dialysis patients with CKD were significantly higher than those without left ventricular diastolic insufficiency and control group CK-MB has the highest accuracy in the area of R0C curve between left ventricular hypertrophy and left ventricular diastolic dysfunction.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692
本文编号：2216722
[Abstract]:[Objective] To compare the changes of high-sensitivity cardiac troponin T (hs-cTnT), N-terminal B-type natriuretic peptide (NT-proBNP) and creatine kinase isoenzyme (CK-MB) in different CKD stages in non-dialysis patients with chronic kidney disease (CKD), and to compare the accuracy of the three parameters in diagnosing the ROC curve area of cardiac structure and function. To find more accurate markers of myocardial damage for predicting cardiac structure and function in non-dialysis patients with chronic kidney disease (CKD), so as to provide some value for early detection of cardiovascular disease in non-dialysis patients with chronic kidney disease. A total of 137 non-dialysis inpatients with chronic kidney disease in January 17 were enrolled in the study. The data of detection of hs-cTnT, NT-proBNP and CK-MB were collected. The included variables included demographic and anthropometric data (gender, age, weight, blood pressure, etc.) and included in the study were primary renal diseases (primary chronic glomerulonephritis, hypertensive nephropathy, lupus nephritis, obstructive nephropathy). Laboratory tests included high-sensitivity cardiac troponin T (hs-cTnT), N-terminal B-type natriuretic peptide (NT-proBNP), creatine kinase isoenzyme (CK-MB), total cholesterol (TC), triglyceride (TG), serum high-density lipoprotein (HDL), serum low-density lipoprotein (LDL), hemoglobin (Hb), serum creatinine (Scr), blood urea nitrogen (BUN). Twenty-nine health examinees from the Second Affiliated Hospital of Kunming Medical University were selected as the control group. Data were analyzed by SPSS 19.0. The measurement data accorded with normal distribution was expressed by mean standard deviation. The comparison between the two samples was performed by t-test and the ratio of three or more samples was compared. Compared with the single factor analysis of variance, the counting data were expressed by the rate, the difference was tested by chi-square analysis, and the diagnostic efficiency of the indexes was evaluated by drawing ROC curve. The diagnostic accuracy was evaluated by the area under the ROC curve, and the P0.05 was statistically significant. [Results] The patients with different CKD groups were statistically analyzed. Compared with the healthy control group, there was no significant difference in gender, age, BMI, TC, TG, HDL and LDL (P 0.05); SP, DP, BUN, SCr index was higher than the control group, the difference was statistically significant (p 0.001), Hb, eGFR was lower than the control group, the difference was statistically significant (p 0.001). CKD between the CKD 5 group and CKD 3-4 group Hb, eGFR index than CKD 1-2. The levels of plasma hs-cTnT, NT-proBNP, CK-MB in CKD1-2 group were higher than those in CKD1-2 group, and the levels of plasma hs-cTnT, NT-proBNP, CK-MB in CKD3-4 group and CKD5 group were higher than those in control group. There were significant differences between the control group (p0.001), and CKD groups: hs-cTnT in CKD 3-4 group and CKD 1-2 group were significantly different (p0.001). hs-cTnT in CKD 5 group (0.2308.1329) was significantly higher than CKD 1-2 group (0.0071.00641), CKD 3-4 group (0.0324.02664), the difference was statistically significant (p0.001). There was no significant difference between CKD3-4 group and CKDD1-2 group. CKD5 group (4.31+2.461) was significantly higher than CKD1-2 group (1.66+1.475) and CKD3-4 group (2.31+1.554), and the difference was statistically significant (p0.001). NT-proBNP had no significant difference between CKD3-4 group and CKD1-2 group, and CKD5 group (1054.21+241.70) was significantly higher than CKD1-2 group (84.25+37.70). The positive rate of hs-cTnT in CKD 3-4 group was higher than that in CKD 1-2 group, the difference was statistically significant (p0.001). The positive rate of CKD 5 group (56.7%) was significantly higher than that in CKD 1-2 group (5.7%) and CKD 3-4 group (28.6%). The positive rate of CKD5 group (53.3%) was significantly higher than CKD1-2 group (0%) and CKD3-4 group (11.9%). The difference was statistically significant (p0.001). The positive rate of serum CK-MB was significantly higher in CKD3-4 group than CKD1-2 group (30%). There was no significant difference in the index of left ventricular systolic dysfunction (EF50%) among the patients with different CKD stages (p0.05); CKD between the groups: CKD 3-4 group, LvDd, IVST, LAD, LVMI, E/A1, LVH index was higher than CKD 1-2 group, the difference was statistically significant (p0.001), LVEF index LvDd, IVST, LVPWT, LVMI in CKD5 group were higher than CKD3-4 group, the difference was statistically significant (p0.001), LVEF index decreased, the difference was statistically significant (p0.001), CKD5 group LvDd, IVST, LVPWT, LVMI, E/A1, LVH index was higher than CKD1-2 group, the difference was statistically significant (p0.001), LVEF index was significantly higher (p0.001). The levels of hs-cTnT, NT-proBNP, CK-MB in CKD patients with left ventricular hypertrophy were significantly higher than those without left ventricular hypertrophy (p0.001). The levels of hs-cTnT, NT-proBNP, CK-MB in CKD patients without left ventricular hypertrophy were significantly higher than those in CKD patients without left ventricular hypertrophy (p0.001). Plasma levels of hs-cTnT, NT-proBNP, CK-MB in patients with CKD were significantly higher than those without left ventricular diastolic dysfunction (p0.001). The levels of hs-cTnT, NT-proBNP and CK-MB in patients without left ventricular diastolic dysfunction were significantly higher than those in normal controls (p0.001). The levels of hs-cTnT, NT-proBNP, CK-MB in patients with CKD were significantly higher than those in normal controls (p0.001). Estimation of left ventricular hypertrophy by R0C curve analysis, CK-MB predictive probability: AUC = (0.818 + 0.035) (95% CI: 0.749-0.887, p0.001), CK-MB assessment of left ventricular hypertrophy the highest accuracy, followed by NT-proBNP, hs-cTnT. According to the plasma levels of hs-cTnT, NT-proBNP, CK-MB in patients with CKD, draw the subjects'working characteristic curve to assess left ventricular diastolic function. The predictive probability of CK-MB: AUC = 0.774 (+ 0.048) (95% CI: 0.679-0.868, p0.001), the highest accuracy was CK-MB, followed by NT-proBNP, hs-cTnT. [Conclusion] 1. The changes of cardiac structure and function were prevalent in non-dialysis patients with CKD. 2. The levels of hs-cTnT, NT-proBNP, CK-MB in non-dialysis patients with CKD generally increased, and progressed with the deterioration of renal function. The levels of hs-cTnT, NT-proBNP, CK-MB in non-dialysis patients were closely related to cardiac structure and function. Left ventricular hypertrophy and left ventricular diastolic insufficiency patients had higher levels of hs-cTnT, NT-proBNP, CK-MB than those without left ventricular hypertrophy, left ventricular diastolic dysfunction and control group. 4. The levels of hs-cTnT, NT-proBNP, CK-MB in non-dialysis patients with CKD were significantly higher than those without left ventricular diastolic insufficiency and control group CK-MB has the highest accuracy in the area of R0C curve between left ventricular hypertrophy and left ventricular diastolic dysfunction.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692
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