高敏心肌肌钙蛋白T与冠状动脉粥样硬化特征的相关性
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摘要
目的结合影像学检查结果评价高敏心肌肌钙蛋白(hs-cTn)T与冠状动脉粥样硬化病变严重程度的关系。方法选取436例初诊为疑似冠状动脉粥样硬化性心脏病(CAD)并行冠状动脉电子计算机断层扫描(CT)的患者,确诊CAD患者222例(CAD组)、非CAD患者214例(对照组)。检测所有对象的hs-cTnT、血糖(Glu)、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)水平,同时计算估算肾小球滤过率(eGFR)。从病变支数、狭窄程度及斑块性质3个方面分析hs-cTnT与冠状动脉粥样硬化严重程度的相关性。将所有对象按hs-cTnT四分位数(由低到高依次为Q1区、Q2区、Q3区、Q4区)分组,比较不同病变支数、狭窄程度或斑块性质各组患者在Q1～Q4区的分布比例。采用Pearson相关分析和Spearman相关分析评估各指标之间的相关性。采用Logistic回归分析进行多因素分析。结果 CAD患者hs-cTnT、冠状动脉钙化积分(CACS)、Glu、UA随病变支数增多而升高(P<0.05),eGFR随病变支数增多而降低(P<0.05);hs-cTnT、CACS、Glu、UA、Cr、BUN随狭窄程度加重而升高(P<0.05)。Pearson相关分析显示,hs-cTnT与BUN、Cr、UA、Glu呈正相关(r值分别为0.312、0.239、0.134、0.131,P<0.05)。Spearman相关分析显示,hs-cTnT四分位分布与病变支数、狭窄程度、斑块性质均相关(rs值分别为0.249、0.252、0.239,P<0.01)。不同病变特征各组Q1～Q4区的患者比例与对照组比较,差异有统计学意义(P<0.05),随着病变支数的增多、狭窄程度的增加、斑块不稳定性的增大,位于Q4区的患者比例均增高,位于Q1区的患者比例均降低。校正传统风险因素(年龄、性别、高血压史、糖尿病史、吸烟史、饮酒史)及肾功能指标(BUN、Cr、UA、eGFR)后,hs-cTnT不能作为冠状动脉存在病变的独立预测指标。结论 hs-cTnT虽与冠状动脉病变严重程度密切相关,但也受性别、年龄、肾功能及基础疾病的影响,尚不能作为冠状动脉存在病变的独立预测指标。
Objective To evaluate the correlation between high-sensitivity cardiac troponin(hs-cTn)T and the severity of coronary atherosclerosis according the results of medical imaging. Methods A total of 436 patients with suspected coronary atherosclerosis disease(CAD) and undergoing coronary computed tomography(CT) were enrolled. There were 222 cases of CAD(CAD group)and 214 cases of non-CAD(control group). Serum hs-cTnT,blood glucose(Glu),blood urea nitrogen(BUN),creatinine(Cr) and uric acid(UA) levels were determined,and estimated glomerular filtration rate(eGFR) was calculated. The correlation between hscTnT and the severity of coronary atherosclerosis was analyzed from 3 aspects,including the number of stenosed vessels,the degree of stenosis and the vulnerability of plaques. All subjects were classified according to hs-cTnT quartile distribution(Q1,Q2,Q3 and Q4 from low to high). The percentages of patients with stenosed vessels,stenosis and plaques in Q1-Q4 were compared. Pearson correlation analysis and Spearman correlation analysis were used to evaluate the correlation of these indicators. Logistic regression analysis was used for multivariate analysis. Results Hs-cTnT,coronary artery calcification score(CACS),Glu and UA increased with the increasing number of stenosed vessels(P<0.05),while eGFR decreased(P<0.05). Hs-cTnT,CACS,Glu,UA,Cr and BUN increased with the degree of stenosis(P<0.05). Pearson correlation analysis showed that hs-cTnT was positively correlated with BUN,Cr,UA and Glu(r=0.312,0.239,0.134 and 0.131,respectively,P<0.05). The quartile distribution of hs-cTnT was positively correlated with the number of stenosed vessels,the degree of stenosis and the vulnerability of plaques(rs=0.249,0.252 and 0.239,respectively,P<0.01). The percentages in Q1-Q4 had statistical significance with those in control group(P<0.05). With the increasing number of stenosed vessels,the degree of stenosis and the vulnerability of plaques,the percentages in Q4 increased,while the percentages in Q1 decreased. After adjusting for traditional risk factors(age,sex,hypertension,diabetes mellitus,smoking and drinking) and renal function indices(BUN,Cr,UA and eGFR),hs-cTnT could not be an independent predictive factor for coronary atherosclerosis. Conclusions Although hs-cTnT is closely correlated with the severity of coronary atherosclerosis,but it is also affected by sex,age,renal function and other underlying diseases,so it can not be an independent predictive factor for coronary atherosclerosis.
Objective To evaluate the correlation between high-sensitivity cardiac troponin(hs-cTn)T and the severity of coronary atherosclerosis according the results of medical imaging. Methods A total of 436 patients with suspected coronary atherosclerosis disease(CAD) and undergoing coronary computed tomography(CT) were enrolled. There were 222 cases of CAD(CAD group)and 214 cases of non-CAD(control group). Serum hs-cTnT,blood glucose(Glu),blood urea nitrogen(BUN),creatinine(Cr) and uric acid(UA) levels were determined,and estimated glomerular filtration rate(eGFR) was calculated. The correlation between hscTnT and the severity of coronary atherosclerosis was analyzed from 3 aspects,including the number of stenosed vessels,the degree of stenosis and the vulnerability of plaques. All subjects were classified according to hs-cTnT quartile distribution(Q1,Q2,Q3 and Q4 from low to high). The percentages of patients with stenosed vessels,stenosis and plaques in Q1-Q4 were compared. Pearson correlation analysis and Spearman correlation analysis were used to evaluate the correlation of these indicators. Logistic regression analysis was used for multivariate analysis. Results Hs-cTnT,coronary artery calcification score(CACS),Glu and UA increased with the increasing number of stenosed vessels(P<0.05),while eGFR decreased(P<0.05). Hs-cTnT,CACS,Glu,UA,Cr and BUN increased with the degree of stenosis(P<0.05). Pearson correlation analysis showed that hs-cTnT was positively correlated with BUN,Cr,UA and Glu(r=0.312,0.239,0.134 and 0.131,respectively,P<0.05). The quartile distribution of hs-cTnT was positively correlated with the number of stenosed vessels,the degree of stenosis and the vulnerability of plaques(rs=0.249,0.252 and 0.239,respectively,P<0.01). The percentages in Q1-Q4 had statistical significance with those in control group(P<0.05). With the increasing number of stenosed vessels,the degree of stenosis and the vulnerability of plaques,the percentages in Q4 increased,while the percentages in Q1 decreased. After adjusting for traditional risk factors(age,sex,hypertension,diabetes mellitus,smoking and drinking) and renal function indices(BUN,Cr,UA and eGFR),hs-cTnT could not be an independent predictive factor for coronary atherosclerosis. Conclusions Although hs-cTnT is closely correlated with the severity of coronary atherosclerosis,but it is also affected by sex,age,renal function and other underlying diseases,so it can not be an independent predictive factor for coronary atherosclerosis.
引文
[1]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2015》概要[J].中国循环杂志,2016,31(6):521-528.
[2]GBD 2013 Mortality and Causes of Death Collaborators.Global,regional,and national age-sex specific all-cause and cause-specific mortality for 240 causes of death,1990-2013:a systematic analysis for the Global Burden of Disease Study 2013[J].Lancet,2015,385(9963):117-171.
[3]中华人民共和国卫生部.WS 319-2010冠状动脉粥样硬化性心脏病诊断标准[S].北京:中国标准出版社,2010.
[4]LEVEY A S,STEVENS L A,SCHMID C H,et al.A new equation to estimate glomerular filtration rate[J].Ann Intern Med,2009,150(9):604-612.
[5]AGATSTON A S,JANOWITZ W R,HILDNER F J,et al.Quantification of coronary artery calcium using ultrafast computed tomography[J].J Am Coll Cardiol,1990,15(4):827-832.
[6]KOROSOGLOU G,LEHRKE S,MUELLER D,et al.Determinants of troponin release in patients with stable coronary artery disease:insights from CT angiography characteristics of atherosclerotic plaque[J].Heart,2011,97(10):823-831.
[7]OEMRAWSINGH R M,CHENG J M,GARCíA-GARCíA H M,et al.High-sensitivity troponin T in relation to coronary plaque characteristics in patients with stable coronary artery disease;results of the ATHEROREMO-IVUS study[J].Atherosclerosis,2016,247:135-141.
[8]MINGELS A,JACOBS L,MICHIELSEN E,et al.Reference population and marathon runner sera assessed by highly sensitive cardiac troponin T and commercial cardiac troponin T and Iassays[J].Clin Chem,2009,55(1):101-108.
[9]SABATINE M S,MORROW D A,DE LEMOS J A,et al.Detection of acute changes in circulating troponin in the setting of transient stress test-induced myocardial ischaemia using an ultrasensitive assay:results from TIMI 35[J].Eur Heart J,2009,30(2):162-169.
[10]LAUFER E M,MINGELS A M,WINKENS M H,et al.The extent of coronary atherosclerosis is associated with increasing circulating levels of high sensitive cardiac troponin T[J].Arterioscler Thromb Vasc Biol,2010,30(6):1269-1275.
[11]刘丽丽,蒋亚斌.冠心病患者肾功能与冠状动脉病变严重程度相关性的Meta分析[J].心血管病防治知识(学术版),2013,3(5):24-29.
[12]CARDINAELS E P,ALTINTAS S,VERSTEYLEN MO,et al.High-sensitivity cardiac troponin concentrations in patients with chest discomfort:is it the heart or the kidneys as well?[J].PLoS One,2016,11(4):e153300.
[13]ROFFI M,PATRONO C,COLLET J P,et al.2015ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.Task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology(ESC)[J].Eur Heart J,2016,37(3):267-315.
[14]CHENEVIER-GOBEAUX C,BONNEFOY-CUDRAZé,CHARPENTIER S,et al.High-sensitivity cardiac troponin assays:answers to frequently asked questions[J].Arch Cardiovasc Dis,2015,108(2):132-149.
[15]GORE M O,SELIGER S L,DEFILIPPI C R,et al.Age-and sex-dependent upper reference limits for the highsensitivity cardiac troponin T assay[J].J Am Coll Cardiol,2014,63(14):1441-1448.
[16]REITER M,TWERENBOLD R,REICHLIN T,et al.Early diagnosis of acute myocardial infarction in the elderly using more sensitive cardiac troponin assays[J].Eur Heart J,2011,32(11):1379-1389.
[17]SEIFARTH H,SCHLETT C L,LEHMAN S J,et al.Correlation of concentrations of high-sensitivity troponin T and high-sensitivity C-reactive protein with plaque progression as measured by CT coronary angiography[J].JCardiovasc Comput Tomogr,2014,8(6):452-458.
[18]GOPAL D M,LARSON M G,JANUZZI J L,et al.Biomarkers of cardiovascular stress and subclinical atherosclerosis in the community[J].Clin Chem,2014,60(11):1402-1408.
[2]GBD 2013 Mortality and Causes of Death Collaborators.Global,regional,and national age-sex specific all-cause and cause-specific mortality for 240 causes of death,1990-2013:a systematic analysis for the Global Burden of Disease Study 2013[J].Lancet,2015,385(9963):117-171.
[3]中华人民共和国卫生部.WS 319-2010冠状动脉粥样硬化性心脏病诊断标准[S].北京:中国标准出版社,2010.
[4]LEVEY A S,STEVENS L A,SCHMID C H,et al.A new equation to estimate glomerular filtration rate[J].Ann Intern Med,2009,150(9):604-612.
[5]AGATSTON A S,JANOWITZ W R,HILDNER F J,et al.Quantification of coronary artery calcium using ultrafast computed tomography[J].J Am Coll Cardiol,1990,15(4):827-832.
[6]KOROSOGLOU G,LEHRKE S,MUELLER D,et al.Determinants of troponin release in patients with stable coronary artery disease:insights from CT angiography characteristics of atherosclerotic plaque[J].Heart,2011,97(10):823-831.
[7]OEMRAWSINGH R M,CHENG J M,GARCíA-GARCíA H M,et al.High-sensitivity troponin T in relation to coronary plaque characteristics in patients with stable coronary artery disease;results of the ATHEROREMO-IVUS study[J].Atherosclerosis,2016,247:135-141.
[8]MINGELS A,JACOBS L,MICHIELSEN E,et al.Reference population and marathon runner sera assessed by highly sensitive cardiac troponin T and commercial cardiac troponin T and Iassays[J].Clin Chem,2009,55(1):101-108.
[9]SABATINE M S,MORROW D A,DE LEMOS J A,et al.Detection of acute changes in circulating troponin in the setting of transient stress test-induced myocardial ischaemia using an ultrasensitive assay:results from TIMI 35[J].Eur Heart J,2009,30(2):162-169.
[10]LAUFER E M,MINGELS A M,WINKENS M H,et al.The extent of coronary atherosclerosis is associated with increasing circulating levels of high sensitive cardiac troponin T[J].Arterioscler Thromb Vasc Biol,2010,30(6):1269-1275.
[11]刘丽丽,蒋亚斌.冠心病患者肾功能与冠状动脉病变严重程度相关性的Meta分析[J].心血管病防治知识(学术版),2013,3(5):24-29.
[12]CARDINAELS E P,ALTINTAS S,VERSTEYLEN MO,et al.High-sensitivity cardiac troponin concentrations in patients with chest discomfort:is it the heart or the kidneys as well?[J].PLoS One,2016,11(4):e153300.
[13]ROFFI M,PATRONO C,COLLET J P,et al.2015ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.Task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology(ESC)[J].Eur Heart J,2016,37(3):267-315.
[14]CHENEVIER-GOBEAUX C,BONNEFOY-CUDRAZé,CHARPENTIER S,et al.High-sensitivity cardiac troponin assays:answers to frequently asked questions[J].Arch Cardiovasc Dis,2015,108(2):132-149.
[15]GORE M O,SELIGER S L,DEFILIPPI C R,et al.Age-and sex-dependent upper reference limits for the highsensitivity cardiac troponin T assay[J].J Am Coll Cardiol,2014,63(14):1441-1448.
[16]REITER M,TWERENBOLD R,REICHLIN T,et al.Early diagnosis of acute myocardial infarction in the elderly using more sensitive cardiac troponin assays[J].Eur Heart J,2011,32(11):1379-1389.
[17]SEIFARTH H,SCHLETT C L,LEHMAN S J,et al.Correlation of concentrations of high-sensitivity troponin T and high-sensitivity C-reactive protein with plaque progression as measured by CT coronary angiography[J].JCardiovasc Comput Tomogr,2014,8(6):452-458.
[18]GOPAL D M,LARSON M G,JANUZZI J L,et al.Biomarkers of cardiovascular stress and subclinical atherosclerosis in the community[J].Clin Chem,2014,60(11):1402-1408.