社区人群中高敏心肌肌钙蛋白T与心血管事件的关系

发布时间：2018-03-18 15:24

本文选题：生物标记物　切入点：高敏心肌肌钙蛋白T　出处：《中国人民解放军医学院》2015年博士论文　论文类型：学位论文

【摘要】：背景：近期出现了心肌肌钙蛋白T的高敏测量方法(high-sensitivity cardiac troponin T,hs-cTnT),该测量方法不仅可以检测出低浓度的cTnT而且提高了检测精确度,可以发现细微的心肌损伤。这种极低水平的循环cTnT可以在部分社区人群中检测到,然而社区人群中可测出hs-cTnT的决定因素及临床意义目前尚不清楚。蛋白尿是不良心血管事件的重要预测因子,在无症状的社区人群中尿蛋白排泄是否与极低水平的hs-cTnT释放相关未见这方面的报道。方法：对于2007年至2009年间入选的1631名无心血管疾病的社区人群(平均年龄62.4岁,58.1%的女性)使用高敏方法测量了基线的cTnT的水平,此后对于该社区群体随访至2013年,重点调查了死亡和新发心血管事件等。随访时我们复测了hs-cTnT和增测了尿白蛋白肌酐比值(urine albumin-creatinine ratio,UACR)。我们既评价了hs-cTnT在横断面上与心血管危险因素的关系,又分析了hs-cTnT的基线值和变化值与未来事件的纵向联系。hs-cTnT与事件的分析使用Cox比例风险模型并调整了多重相关因素。结果：hs-cTnT可以在54.6%的参与者中测出,11.4%的受试者出现了hs-cTnT的升高(≥14 pg/mL)。经多变量logistic回归分析显示：年龄,男性,糖尿病和降低的肾功能(估算肾小球滤过率)是hs-cTnT可测出或升高的独立影响因素。此外,UACR农度(标准化回归系数=0.102,P0.001)是hs-cTnT的独立预测因素,UACR水平(优势比=1.40；95% CI：1.08-1.65；P=0.002)与hs-cTnT的升高相关,全变量调整logistic回归分析显示：那些在UACR最高四分位的参与者发生hs-cTnT升高的风险是最低四分位的2.43倍(95% CI:1.25-5.08;P=0.006)。经过中位时间为4.8年的随访,有52名参与者死亡,其中包括24名心血管疾病死亡;154名参与者出现了新发的主要心血管事件,其中99名出现了冠心病事件,另有61例各种类型的卒中。在多变量调整模型中,hs-cTnT与卒中以外的各终点事件相关；相比于hs-cTnT未测出的参与者,那些hs-cTnT水平在最高分组(≥14 pg/mL)的受试者全因死亡(风险比[hazard ratio,HR]=2.07;95%置性区间[confidence interval,CI], 1.05-3.01),心血管死亡(HR=2.71; 95% CI,1.42-7.03),心血管事件(HR=3.27; 95% CI,1.88-5.70)和冠心病事件(HR=4.50; 95% CI,2.26-9.02)风险均显著增加。即使hs-cTnT轻度升高(≥6.22 pg/mL)也与增加的心血管和冠心病事件风险相关。当调整了传统危险因素,基线的hs-cTnT水平和N-末端脑利钠肽前体后hs-cTnT动态相对值变化和绝对值变化均与较高的心血管事件风险相关,在那些基线时可测到hs-cTnT的参与者中随访时如果出现hs-cTnT水平上升超过50%,其发生心血管事件的风险(HR= 1.65; 95% CI,1.04-2.63)和冠心病事件的风险(HR=1.76; 95% CI,1.10 to 2.86)均较hs-cTnT水平变化在50%以内的人群增加。结论：在社区无明确心血管疾病的人群中,无论是基线hs-cTnT水平还是hs-cTnT的变化值均与未来死亡及心血管事件的风险相关,在临床实践中可作为筛选高危人群的工具。在一般人群中尿蛋白排泄增多与升高的hs-cTnT相关,提示蛋白尿除了与血管内皮功能紊乱外可能还会引起亚临床心肌损伤。
[Abstract]:Background: recent Gao Min measurements of cardiac troponin T (high-sensitivity cardiac troponin T, hs-cTnT), this method can not only detect the low concentration of cTnT and improve the detection accuracy, can be found in myocardial damage slightly. The extremely low levels of circulating cTnT can be detected in the community population, however, and clinical the significance can measure the determinants of hs-cTnT in community population is unclear. Proteinuria is an important predictor of adverse cardiovascular events, whether urinary protein excretion in asymptomatic community population reported with very low levels of hs-cTnT release was related to this aspect. Methods: for 1631 subjects without cardiovascular disease in community population in 2007 to 2009 years (mean age 62.4 years, 58.1% women) using the Gao Min method to measure the baseline levels of cTnT, then for the community Follow up to 2013, focusing on the investigation of the death and cardiovascular events. We were complex and hs-cTnT were measured by measuring the urinary albumin creatinine ratio (urine albumin-creatinine ratio, UACR). We evaluated the relationship between hs-cTnT and cardiovascular risk factors in cross section, and analyzed the longitudinal relationship between.Hs-cTnT and hs-cTnT events baseline values and changes of value and future events using Cox proportional hazard model and adjusted multiple correlation factors. Results: hs-cTnT can be detected in 54.6% of the participants, 11.4% of the subjects had increased hs-cTnT (pg/mL = 14). Multivariate logistic regression analysis showed that age, male, diabetes and reducing the renal function (glomerular filtration rate) were independent factors of hs-cTnT can be measured or increased. In addition, UACR concentration (standard regression coefficient =0.102, P0.001) is an independent predictor of hs-cTnT Factor UACR levels (odds ratio =1.40, 95%; CI:1.08-1.65; P=0.002) associated with the increase of hs-cTnT, the adjusted logistic regression analysis showed that the risk of UACR in the highest four points participants with elevated hs-cTnT is 2.43 times the minimum four points (95% CI:1.25-5.08; P=0.006). After a median of 4.8 years the follow-up, 52 participants died, including 24 deaths from cardiovascular disease; 154 participants had developed new onset of major cardiovascular events, 99 of these patients had coronary events, stroke and 61 cases of various types. In multivariable adjusted model, the end point events outside hs-cTnT and stroke compared to related; hs-cTnT was not found in the participants, those in the highest level of hs-cTnT group (pg/mL = 14) subjects all-cause mortality (hazard ratio [hazard ratio, HR]=2.07; 95% of the range of [confidence interval, CI], 1.05-3.0 1), cardiovascular death (HR=2.71; 95% CI, 1.42-7.03), cardiovascular events (HR=3.27 95%; CI, 1.88-5.70) and coronary heart disease (HR=4.50; 95% CI, 2.26-9.02) risk increased significantly. Even mildly elevated hs-cTnT (6.22 pg/mL) is also associated with increased risk of coronary heart disease and cardiovascular events. When the traditional adjustment the risk factors, baseline levels of hs-cTnT and N- terminal pro brain natriuretic peptide after hs-cTnT dynamic changes in the relative value and absolute value of change was associated with a higher risk of cardiovascular events, in the baseline can be measured to hs-cTnT participants in follow-up if the level of hs-cTnT increased by more than 50%, the risk of cardiovascular events (HR= 1.65; 95% CI, 1.04-2.63) and the risk of coronary heart disease events (HR=1.76; 95% CI, 1.10 to 2.86) were lower than hs-cTnT levels increased within 50% of the population. Conclusion: there is no clear cardiovascular disease in the community population, Regardless of changes in the baseline level of hs-cTnT or hs-cTnT values were associated with risk of death and cardiovascular events in the future, in clinical practice can be used as a tool for the screening of high-risk population in the general population. The urinary protein excretion increased associated with elevated hs-cTnT, in addition to proteinuria and endothelial dysfunction may also cause subclinical myocardial injury.

【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R54

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