The Correlation Studies Between Chronic Kidney Disease Patients Serum Cardiac Troponin ? Numerical Detection And The Diagnosis Of Myocardial Infarction

ObjectiveTo evaluate the difference of the cTnI concentration between patients with chronic kidney disease(CKD),treated conservatively or with hemodialysis,and its role in the diagnosis of acute myocardial infarction(AMI);To explore the related factors which can lead to the increased of cTnI;To explore the related risk factors which can lead to the AMI in these groups.MethodsSubjects in this clinical study excluded people who were younger than 18 years of age,who were made a definite diagnosis of Diabetes Mellitus,heart failure(NYHA ?or ?level).Use the MDRD formula to calculate creatinine clearance rate.The study population consisted of six Groups: Group 1:Healthy control group(n=20)11 women,9 men,mean age 49.7±11.9 years,Without Chronic Kidney Diseases with creatinine clearance(Ccr)121.43±19.37ml/min;Group 2:CKD without hemodialysis and AMI group(n=25)9 women,16 men,mean age50.8±14.2years,Ccr is 11.59±8.36ml/min.Group 3:MHD patients without AMI group(n=26)17 women,9 men,mean age 53.6±10.2 years;Group 4:Normal renal function with AMI patients group(n=26)10 women,16 men,mean age 62.35±8.94 years,Ccr is 99.68±29.27ml/min;Group 5: Patients with CKD and AMI group(n=16)6 women,10 men,mean age 67.44±12.37 years,Ccr=10.18±5.11ml/min;Group 6:MHD patients with AMI group(n=16)7 women,9 men,mean age 59.63±12.37 years.Model and specification of dialyzer were in no difference in group 3 and group 6;Stable hemodialysis more than six months;The frequencies of dialysis were both 3 times per week,dialysate flow 500 ml/min,blood flow velocity 230 m1/min,Use bicarbo-nate dialysate.AMI was diagnosed by clinical symptoms(dyspnea and chest pain),elevation of cTnI and CK-MB,and manifestation of electrocardiogram in development.The hemoglobin,high sensitivity C-reactive protein(hsCRP),parathyroid hormone(PTH),createnine,urea nitrogen,uric acid(UA)and other biochemical indicators were determined.Blood pressure was recorded.Echocardiography was performed and left ventricular mass index(LVMI)was calculated.These data were processed by SPSS 20.0.Using single factor analysis of variance to research the difference level of cTnI in group 1,2,3 groups have statistical significance or not;Using single factor analysis of variance to research the difference level of cTnI in group 4,5,6 groups have statistical significance or not;Through the different boundary value in the diagnosis of AMI to calculate sensitivity,specificity,positive predictive value,negative predictive value to choose diagnostic critical value in AMI patients with CKD;By multiple linear correlative analysis to research the relationship between cTnI and age,blood pressure,hemoglobin,c-reactive protein,parathyroid hormone,left ventricular ejection fraction in 2 and 5 group;By multiple linear correlative analysis to research the relationship between cTnI and age,blood pressure,hemoglobin,c-reactive protein,parathyroid hormone,left ventricular ejection fraction in 3 and 6 group;By logistic regression analysis,to research AMI risk factors in 2 and 5 group;By logistic regression analysis,to research AMI risk factors in 3 and 6 group.Result1.Compared with Group 1,the cTnI values were significantly higher in Group 2 and Group 3(P<0.01,respectively),(0.0005 ± 0.0022ng/ml Vs 0.1448 ± 0.1231ng/ml Vs 0.2888 ± 0.1831ng/ml),especially in Group 3.In Group 2 cTnI concentration was over the normal range(0.1ng/ml)in 52% of patients,and cTnI concentration exceeded the acute myocardial infarction diagnostic cut-off(0.2ng/ml)in 28% of patients.In Group 3 cTnI concentration was over the normal level in 88% of patients,and cTnI concentration exceeded the acute myocardial infarction diagnostic cut-off in 53.8% of patients.2.The cTnI values in Group 4,Group 5 and Group 6 is(4.6050 ± 2.80834ng/ml Vs 6.5909 ± 1.5957ng/ml Vs 8.3260 ± 4.41670ng/ml).By the mean of the pairwise comparison,the 4 group compared with 5 is P = 0.998,greater than 0.05,shows that 4 group and 5 group's cTnI values was no statistically significant difference.The 4 group compared with 6 is P = 0.002,less than 0.05,shows that 4 group and 6 group's cTnI values was statistically significant difference.The 5 group compared with 6 is P = 0.003,less than 0.05,shows that 5 group and 6 group's cTnI values was statistically significant difference.3.CKD patients with AMI,cTnI within 2 to 6h to be detected,numerical more than 0.6 ng/ml,the sensitivity,specificity and positive predictive value,negative predictive value were higher in the diagnosis of AMI.4.The cTnI levels in CKD patients treated conservatively relateded with age(r= 0.464),hemoglobin(r=0.354),CKMB(r=0.583),c-reactive protein(r=0.627),left ventricular ejection fraction(r = 0.468),There are statistically significant.5.The cTnI levels in CKD patients treated with hemodialysis relateded with age(r= 0.314),CK-MB(r=0.646),c-reactive protein(r=0.626),Parathyroid hormone(r=0.330),left ventricular ejection fraction(r =-0.385),There are statistically significant.Conclusions1.Chronic kidney disease is associated with increased cTnI concentration.This may be related to the reduce of cTnI's clearance and cTnI metabolites retention in chronic kidney disease patients.2.In this study,for patients with chronic kidney disease,the cTnI standard in the diagnosis of acute myocardial infarction is about 0.6 ng/ml,but still need to be combined with clinical manifestations,enzymology and troponin,electrocardiogram,heart doppler ultrasound and so on to exceed comprehensive judgment.3.The elevated cTnI in chronic kidney disease patients are about with elderly,anemia,the inflammatory state,parathyroid hormone,left ventricular ejection fraction and so on.