高敏肌钙蛋白T对肾脏受损的急性心肌梗死患者诊断准确性研究

李广权; 钟培英

doi:10.7619/jcmp.20211396

高敏肌钙蛋白T对肾脏受损的急性心肌梗死患者诊断准确性研究

Diagnosis accuracy of acute myocardial infarction in patients with renal injury using high-sensitivity troponin T

摘要

摘要:
目的探讨高敏肌钙蛋白T（hs-cTnT）对肾脏受损的急性心肌梗死（AMI）患者诊断准确性。
方法根据估算肾小球滤过率（eGFR）不同将纳入研究的1 934例出现胸痛的患者进行分组，分别为eGFR≥90 mL/（min·1.73 m²）组慢性肾脏病（CKD）Ⅰ期689例、eGFR 60~ < 90 mL/（min·1.73 m²）组（CKDⅡ期）889例、eGFR 30~ < 60 mL/（min·1.73 m²）组（CKD Ⅲ期）283例和eGFR < 30 mL/（min·1.73 m²）组（CKD Ⅳ期）73例。比较各组受试者工作特征（ROC）曲线的确定阈值与第99百分位数对应诊断性能差异。
结果在eGFR < 30 mL/（min·1.73 m²）、eGFR 30~ < 60 mL/（min·1.73 m²）及eGFR 60~ < 90 mL/（min·1.73 m²）中，ROC确定阈值与第99百分位数对应敏感度、特异度、阳性预测值、阴性预测值比较，差异均有统计学意义（P < 0.01）。
结论若需使用hs-cTnT准确诊断肾脏受损的AMI患者，其ROC阈值需结合eGFR。

Abstract:
Objective To investigate the diagnostic accuracy of high-sensitivity cardiac troponin T (hs-cTnT) in patients with acute myocardial infarction (AMI) with renal damage.
Methods A total of 1 934 patients with chest pain were divided into different groups based on different estimated glomerular filtration rate (eGFR). There were 689 cases in the group of eGFR ≥90 mL/(min·1.73 m²)chronic kidney disease (CKD) Ⅰ stage, 889 cases in the group of eGFR 60 to < 90 mL/(min·1.73 m²) (CKDⅡ stage), 283 cases in the group eGFR 30 to < 60 mL/(min·1.73 m²) (CKD Ⅲ stage) and 73 cases in the eGFR < 30 mL/(min·1.73 m²) group (CKD Ⅳ stage). Receiver operating characteristic (ROC) curve was used to compare the diagnostic performance between the threshold and the 99th percentile.
Results When eGFR < 30 mL/(min·1.73 m²), eGFR 30 to < 60 mL/(min·1.73 m²) and eGFR 60 to < 90 mL/(min·1.73 m²). Compared with the corresponding sensitivity, specificity, positive predictive value and negative predictive value of the 99th percentile, and the differences in those of the ROC determination threshold were statistically significant (P < 0.01).
Conclusion For AMI patients with kidney damage, the ROC threshold hs-cTnT should be combined with eGFR for accurate diagnosis.

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