【摘要】 目的探讨高敏肌钙蛋白T(high-sensitive cardiac troponin T,hs-cTnT)对慢性肾衰竭(chronic renal failure,CRF)非透析患者急性心肌梗死(acute myocardial infarction,AMI)的诊断价值。方法选取慢性肾脏病4期(chronic kidney disease stage 4,CKD stage 4)非透析合并AMI患者52例(A组),单纯CKD4期非透析患者52例(B组),比较2组患者入院时血清hs-cTnT水平,探讨其对CKD4期非透析患者AMI的最佳诊断值。结果 A组患者血清hs-cTnT水平显著高于B组(P<0.05);左心房内径(left atriumdimension,LAD)、左心室舒张末期内径(left ventricular enddiastolic dimension,LVEDD)、左心室收缩末期内径(left ventricular endsystolic dimension,LVESD)与hs-cTnT成正相关(P<0.01);左心室射血分数(left ventricularejection fraction,LVEF)及肾小球滤过率(glomerular filtration rate,eGFR)与hs-cTnT均成负相关;LVEDD、LVEF及eGFR是血清hs-cTnT浓度的独立影响因素;以72.50 ng/L为临界值,血清hs-cTnT诊断CRF非透析合并AMI的敏感度为75.00%,特异度为90.38%。结论对于CRF非透析患者,相应提高血清hs-cTnT的截断值,可有效提高诊断AMI的特异性。更多还原

【Abstract】 Objective To investigate the diagnostic value of high-sensitive cardiac troponin T(hs-cTnT) in acutemyocardial infarction(AMI)in chronic renal failure(CRF) patients without dialysis. Methods A total of 52 patients with chronic kidney disease stage 4(CKD stage 4)and without dialysis complicated with AMI(Group A) and 52 patients with CKD stage 4 and without dialysis(Group B) were enrolled in this study. The levels of hs-cTnT in the serum of the two groups at admission were compared, and the optimal diagnostic value for AMI in CKD stage 1 patients without dialysis was discussed. Results The level of hs-cTnT was significantly higher in group A than in group B(P<0.05). hs-cTnT was positively correlated with left atrium dimension(LAD),left ventricular end diastolic dimension(LVEDD)and left ventricular end systolic dimension(LVESD)(P<0.01). In addition, hs-cTnT was negatively correlated with left ventricular ejection fraction(LVEF)and glomerular filtration rate(eGFR). LVEDD,LVEF and eGFR were the independent influencing factors of hs-cTnT level.The sensitivity and specificity of hs-cTnT in the diagnosis of AMI in CRF patients without dialysis was 75.00% and 90.38% respectively, with 72.50 ng/L as the cut-off value. Conclusion For CRF patients without dialysis, increasing hs-cTnT cut-off value can effectively improve the specificity in AMI diagnosis.更多还原