急性失代偿和慢性心力衰竭患者肌钙蛋白升高的相关预测因素

IF 0.5 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL
A. Draghici, C. A. Buzea, C. Delcea, A. Vîjan, G. Dan
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引用次数: 0

摘要

背景:由高敏感性肌钙蛋白(hs-Tn)升高表达的心肌损伤(INJ)在心血管和非心脏疾病引起的心力衰竭(HF)中很常见。INJ在急性失代偿性心衰(ADHF)和慢性心衰(CHF)中的作用机制仍存在争议。本研究的目的是评估ADHF和CHF中hs-TnT升高的决定因素。方法:我们回顾性分析连续的心衰患者入院时的hs-TnT测量,在一家三级医院住院。排除再住院、急性冠状动脉综合征、栓塞、感染、自身免疫和恶性肿瘤。hs-TnT的临界值为14 ng/L。结果:本研究纳入488例HF患者,56.55%合并ADHF。平均年龄72.52±10.09岁。53.89%为女性。67.75% ADHF和45.75% CHF患者hs-TnT升高。ADHF患者的中位hs-TnT高于CHF患者(21.05[IQR 12.74-33.81] vs 13.20[IQR 7.93-23.25], p<0.0001)。在ADHF和CHF的多变量分析中,log10NT-proBNP (HR=5.30, 95%CI 2.71 ~ 10.38, p<0.001,分别为HR=5.49, 95%CI 1.71 ~ 17.57, p=0.004)和eGFR (HR=0.72, 95%CI 0.62 ~ 0.85, p<0.001,分别为HR=0.71, 95%CI 0.55 ~ 0.93, p=0.014)是hs-TnT升高的独立预测因子。与ADHF患者hs-TnT升高相关的独立因素为男性(HR=2.52, 95%CI 1.31-4.87, p=0.006)和慢性肺阻塞性疾病(COPD) (HR=10.57, 95%CI 1.26-88.40, p=0.029),而CHF患者为年龄(HR=2.68, 95%CI 1.42-5.07, p=0.002)和既往卒中(HR=5.35, 95%CI 0.98-29.20, p=0.053)。结论:由NT-proBNP水平表达的HF严重程度和由eGFR表达的肾脏疾病进展是ADHF和CHF中hs-TnT升高的独立预测因素。在ADHF(男性,COPD)和CHF(年龄,卒中史)中也发现了特定的独立预测因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predictors associated with increased troponin in acute decompensated and chronic heart failure patients
Abstract Background: Myocardial injury (INJ) expressed by elevated high-sensitivity troponin (hs-Tn) is common in heart failure (HF), due to cardiovascular and non-cardiac conditions. The mechanisms of INJ in acute decompensated HF (ADHF) versus chronic HF (CHF) are still debated. This study’s purpose was to evaluate the determinants of elevated hs-TnT in ADHF and CHF. Methods: We retrospectively analyzed consecutive HF patients with hs-TnT measured on admission, hospitalized in a tertiary-care hospital. Rehospitalizations, acute coronary syndromes, embolisms, infections, autoimmunity and malignancy were excluded. Cut-off point for hs-TnT was 14 ng/L. Results: Our study included 488 HF patients, 56.55% with ADHF. Mean age was 72.52±10.09 years. 53.89% were females. 67.75% ADHF and 45.75% CHF patients had elevated hs-TnT. Median hs-TnT was higher in ADHF versus CHF (21.05[IQR 12.74-33.81] vs 13.20[IQR 7.93-23.25], p<0.0001). In multivariable analysis in ADHF and CHF, log10NT-proBNP (HR=5.30, 95%CI 2.71–10.38, p<0.001, respectively HR=5.49, 95%CI 1.71–17.57, p=0.004) and eGFR (HR=0.72, 95%CI 0.62–0.85, p<0.001, respectively HR=0.71, 95%CI 0.55–0.93, p=0.014) were independent predictors for increased hs-TnT. Independent factors associated with elevated hs-TnT in ADHF were male sex (HR=2.52, 95%CI 1.31-4.87, p=0.006) and chronic pulmonary obstructive disease (COPD) (HR=10.57, 95%CI 1.26-88.40, p=0.029), while in CHF were age (HR=2.68, 95%CI 1.42-5.07, p=0.002) and previous stroke (HR=5.35, 95%CI 0.98-29.20, p=0.053). Conclusion: HF severity, expressed by NT-proBNP levels, and kidney disease progression, expressed by eGFR, were independent predictors associated with increased hs-TnT in both ADHF and CHF. Specific independent predictors were also indentified in ADHF (male sex, COPD) and CHF (age, history of stroke).
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来源期刊
Revista Romana De Medicina De Laborator
Revista Romana De Medicina De Laborator MEDICINE, RESEARCH & EXPERIMENTAL-
CiteScore
0.31
自引率
20.00%
发文量
43
审稿时长
>12 weeks
期刊介绍: The aim of the journal is to publish new information that would lead to a better understanding of biological mechanisms of production of human diseases, their prevention and diagnosis as early as possible and to monitor therapy and the development of the health of patients
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