目的：：前瞻性观察维持性血液透析(MHD)患者肌钙蛋白 T(TnT)、肌钙蛋白 I(TnI)水平及急性冠脉综合征(ACS)发病率，并对比两者 TnT 、TnI 对于 ACS 的预测诊断价值。方法：选取海淀区3个透析中心治疗3月以上的 MHD 患者220例，记录患者临床资料，检测受试者血清肌钙蛋白 T(TnT)、肌钙蛋白 I(TnI)水平，记录患者临床资料，随访随后1000 d ACS 发生情况；比较 TnT、TnI 对于 ACS 的预测诊断意义。结果：随访期间29例患者发生 ACS，发病率约为13．2%(29例／1000病人年)。220例患者中 TnT 阳性率15．91%(35／220)，TnI 阳性率11．4%(25／220)，ROC 曲线分析显示 TnT≥0．09， TnI≥0．05时诊断 ACS 效能最高，特异度分别为77．7%，67．6%，敏感性分别为82．8%，96．6%，ROC 曲线下面积分别为0．848，0．744，诊断效能差异无统计学意义(P =0．11)。结论：北京市海淀区 MHD 患者 ACS 发生率为13．2%，TnT 阳性率高于 TnI，两者均可用于预测 ACS 诊断，诊断效能相当。 MHD 患者常规开展肌钙蛋白检测有助于发现 ACS 高危人群。%Objective:The cohort study was designed to investigate level of Troponin T (TnT), Troponin I (TnI) and inci-dence of acute coronary syndrome(ACS) in maintenance hemodialys patients(MHD), the prognostic value of TnT and TnI for ACS was also evaluated. Methods:TnT, TnI were measured, Clinical data collected at baseline(January 2012) in 220 HD patients in three hemodialysis centers in Haidian District of Beijing. ACS events in the next 1000 days were recorded. Results:ACS was diag-nosed in 29 patients during follow - up (29 / 1000 person - years), the incidence is 13. 2% . TnT was positive in 35 cases (15. 91% ) and TnI was positive in 25 cases (11. 4% ) among 220 patients. ROC curve analysis showed a moderate predictive value for TnT(≥0. 09) and TnI(≥0. 05) for ACS of HD patients. Specificity of TnI and TnT were 77. 7% , 67. 6% and sensitivity were 82. 8% , 96. 6% respectively. There were no difference in diagnostic efficacy of TnI and TnT, the area under ROC curve of both were 0. 848, 0. 744, respectively (P = 0. 11). Conclusion:The incidence of ACS was 13. 2% in Haidian District of Beijing. Serum TnT and TnI appears to be valuable predictive markers of ACS events in asymptomatic dialysis patients. The routine test of Tn in MHD patients will help screening high - risk people of ACS.
展开▼
