慢性腎臟病非透析患者血hs-cTnT、NT-proBNP、CK-MB評(píng)估心臟結(jié)構(gòu)功能的臨床價(jià)值比較
發(fā)布時(shí)間：2018-09-01 09:08
【摘要】：[目的]比較慢性腎臟病(chronic kidney disease, CKD)非透析患者血高敏心肌肌鈣蛋白T(hs-cTnT)、N末端B型利鈉肽原(NT-proBNP)、肌酸激酶同工酶(CK-MB)指標(biāo)水平在不同CKD分期的變化情況,以及比較三者在診斷心臟結(jié)構(gòu)功能的ROC曲線面積的準(zhǔn)確性,為進(jìn)一步尋找預(yù)測(cè)慢性腎臟病(CKD)非透析患者心臟結(jié)構(gòu)功能較為準(zhǔn)確的心肌損傷標(biāo)志物提供臨床依據(jù),以便為早期發(fā)現(xiàn)慢性腎臟病非透析患者心血管疾病提供一定價(jià)值。[方法]入選標(biāo)準(zhǔn)為昆明醫(yī)科大學(xué)第二附屬醫(yī)院腎臟內(nèi)科2015年1月-2017年1月慢性腎臟病非透析住院患者共137例,收集含有hs-cTnT、NT-proBNP、CK-MB指標(biāo)的檢測(cè)資料,納入研究變量包括人口學(xué)及人體測(cè)量資料(性別、年齡、體重、血壓等)、納入腎臟原發(fā)疾病(原發(fā)慢性腎小球腎炎、高血壓腎損害、狼瘡性腎炎、梗阻性腎病、ANCA相關(guān)性腎炎等)。納入實(shí)驗(yàn)室檢查指標(biāo)包括高敏心肌肌鈣蛋白T(hs-cTnT)、N末端B型利鈉肽原(NT-proBNP)、肌酸激酶同工酶(CK-MB)、總膽固醇(TC)、甘油三酯(TG)、血清高密度脂蛋白(HDL)、血清低密度脂蛋白(LDL)、血紅蛋白(Hb)、血肌酐(Scr)、血尿素氮(BUN)以及納入心臟超聲檢查指標(biāo)等。選取同期到昆明醫(yī)科大學(xué)第二附屬醫(yī)院進(jìn)行健康體檢人員29例,作為對(duì)照組。采用spss19.0進(jìn)行數(shù)據(jù)分析,計(jì)量資料符合正態(tài)分布采用均數(shù)標(biāo)準(zhǔn)差進(jìn)行表示,兩樣本間比較采用t檢驗(yàn),三個(gè)及以上樣本間比較采用單因素方差分析;計(jì)數(shù)資料采用率進(jìn)行表示,采用卡方分析進(jìn)行差異性檢驗(yàn),繪制ROC曲線對(duì)指標(biāo)的診斷效能進(jìn)行評(píng)價(jià),由ROC曲線下面積綜合評(píng)價(jià)診斷準(zhǔn)確性,以p0. 05表示有統(tǒng)計(jì)學(xué)意義。[結(jié)果]經(jīng)統(tǒng)計(jì)學(xué)分析不同CKD分組的病例組患者與健康對(duì)照組比較,在性別、年齡、BMI、TC、TG、HDL及LDL指標(biāo)差異無統(tǒng)計(jì)學(xué)意義(P0.05);在SP、DP、BUN、SCr指標(biāo)上高于對(duì)照組,差異具有統(tǒng)計(jì)意義(p0.001),Hb、eGFR低于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(p0. 001)。CKD各組間比較:CKD5組與CKD3-4組患者Hb、eGFR指標(biāo)較CKD1-2組降低,差異有統(tǒng)計(jì)意義(p0.001),SP、DP、BUN、SCr指標(biāo)較CKD1-2組升高,差異有統(tǒng)計(jì)意義(p0. 001)。經(jīng)統(tǒng)計(jì)學(xué)分析,CKD1-2組血漿hs-cTnT、NT-proBNP、CK-MB指標(biāo)水平與對(duì)照組比較指標(biāo)差異無統(tǒng)計(jì)學(xué)意義,CKD3-4組與CKD5組血漿hs-cTnT、NT-proBNP、CK-MB指標(biāo)水平升高,與對(duì)照組比較差異有統(tǒng)計(jì)學(xué)意義(p0.001),而CKD各組間比較:hs-cTnT在CKD3-4組與CKD1-2組之間比較差異有統(tǒng)計(jì)學(xué)意義(p0. 001), hs-cTnT在CKD5 組(0.2308±0. 1329)明顯高于 CKD1-2 組(0.0071 ±0.00641 )、CKD3-4組(0. 0324±0. 02664),差異有統(tǒng)計(jì)學(xué)意義(p0. 001 )。CK-MB 在 CKD3-4 組與CKDD1-2組之間比較差異無統(tǒng)計(jì)學(xué)意義,CKD5組(4.31±2.461)明顯高于CKD1-2組(1.66±1.475)、CKD3-4 組(2.31±1.554),差異有統(tǒng)計(jì)學(xué)意義(p0.001)。NT-proBNP在CKD3-4組與CKD1-2之間比較差異無統(tǒng)計(jì)學(xué)意義,在CKD5組(1054.21±241.70)明顯高于CKD1-2組(84.25±37.728)、CKD3-4組(475.08±388.761),差異有統(tǒng)計(jì)學(xué)意義(p0. 001)。CKD各組間比較:血hs-cTnT陽性率在CKD3-4組較CKD1-2組升高,差異具有統(tǒng)計(jì)學(xué)意義(p0. 001 ),CKD5組陽性率(56.7%),明顯高于CKD1-2組(5.7%)、CKD3-4組(28.6%),差異有統(tǒng)計(jì)學(xué)意義(p0.001)。NT-ProBNP陽性率在CKD3-4組與CKD1-2組之間比較,差異具有統(tǒng)計(jì)學(xué)意義(p0. 001 ),CKD5組陽性率(53. 3%)明顯高于CKD1-2組(0%)、CKD3-4組(11. 9%),差異有統(tǒng)計(jì)學(xué)意義(p0. 001 )。血清CK-MB陽性率在CKD3-4組與CKD1-2組之間比較,差異無統(tǒng)計(jì)學(xué)意義,CKD5組陽性率(30%)明顯高于CKD1-2組(2.8%)、CKD3-4組(4.7%),差異有統(tǒng)計(jì)學(xué)意義(p0.001)。不同CKD分期的患者在左室收縮功能不全指標(biāo)(EF50%)指標(biāo)上差異無統(tǒng)計(jì)學(xué)意義(p0. 05); CKD 各組間比較:CKD3-4 期組患者,LvDd、IVST、LAD、LVMI、E/A1、LVH指標(biāo)較CKD1-2期升高,差異具有統(tǒng)計(jì)學(xué)意義(p0.001),LVEF指標(biāo)下降,差異具有統(tǒng)計(jì)學(xué)意義(p0.001),CKD5組患者LvDd、IVST、LVPWT、LVMI指標(biāo)較CKD3-4組升高,差異具有統(tǒng)計(jì)學(xué)意義(p0.001),LVEF指標(biāo)下降,差異具有統(tǒng)計(jì)學(xué)意義(p0.001),CKD5 組患者 LvDd、IVST、LVPWT、LVMI、E/A1、LVH指標(biāo)較CKD1-2組升高,差異具有統(tǒng)計(jì)學(xué)意義(p0.001),LVEF指標(biāo)下降,差異具有統(tǒng)計(jì)學(xué)意義(p0. 001)。經(jīng)統(tǒng)計(jì)學(xué)分析伴有左心室肥厚CKD患者血漿hs-cTnT、NT-proBNP、CK-MB水平較無左心室肥厚、正常對(duì)照組顯著升高(p0.001),無左心室肥厚組hs-cTnT、NT-proBNP、CK-MB水平較正常對(duì)照組升高(p0. 001),伴有左室舒張功能不全的CKD患者血漿hs-cTnT、NT-proBNP、CK-MB水平較無左室舒張功能不全、正常對(duì)照組顯著升高(p0. 001),無左心室舒張功能不全組hs-cTnT、NT-proBNP、CK-MB水平較正常對(duì)照組升高(p0.001)。CKD患者血漿hs-cTnT、NT-proBNP、CK-MB水平,繪制受試者工作特征曲線評(píng)估左室肥厚。經(jīng)R0C曲線分析得,CK-MB預(yù)測(cè)概率:AUC=(0.818± 0.035 )(95%CI:0.749-0.887,p0.001),CK-MB評(píng)估左室肥厚準(zhǔn)確率最高,其次NT-proBNP,hs-cTnT。根據(jù) CKD 患者血漿 hs-cTnT、NT-proBNP、CK-MB 水平,繪制受試者工作特征曲線評(píng)估左室舒張功能。經(jīng)ROC曲線分析得,CK-MB預(yù)測(cè)概率:AUC= (0.774±0. 048) (95%CI:0. 679-0.868, p0. 001),準(zhǔn)確性最高是 CK-MB,其次 NT-proBNP, hs-cTnT。[結(jié)論]1. CKD非透析患者普遍存在心臟結(jié)構(gòu)與功能的改變。2. CKD非透析患者血漿hs-cTnT、NT-proBNP、CK-MB水平普遍升高,并且隨著腎功能惡化而進(jìn)行性升高。3. CKD非透析患者血漿hs-cTnT、NT-proBNP、CK-MB水平與心臟結(jié)構(gòu)功能密切相關(guān),左室肥厚與左室舒張不全患者血hs-cTnT、NT-proBNP、CK-MB水平較無左室肥厚、無左室舒張功能不全及對(duì)照組顯著升高。4. CKD非透析患者血漿hs-cTnT、NT-proBNP、CK-MB診斷左室肥厚與左室舒張功能不全的R0C曲線面積,CK-MB準(zhǔn)確性最高。檢測(cè)CK-MB可作為CKD早期心血管疾病的可靠指標(biāo)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.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692
本文編號(hào)：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.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692
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