目的 明确血液透析患者急性心肌梗死(acute myocardial infarction,AMI)期心肌肌钙蛋白T(cardiac troponin T,cTnT)水平的变异情况，并分析其临床价值。 方法 回顾性分析血液透析患者和肾功能正常者AMI期cTnT水平及变化趋势的差异，明确cTnT水平与AMI程度的关系及对再发AMI、死亡的预测效果。 结果 在非AMI期，透析患者cTnT基线[147.25(92.85,236.65)ng/L]较肾功能正常患者[25.0(15.0,52.3)ng/L]升高(Z=-11.595,P＜0.001)；cTnT诊断AMI的截断值为396.45 ng/L。在AMI期，透析患者cTnT峰值(1938.0 ng/L)高于肾功能正常患者(1036.5 ng/L)(Z=-6.041,P＜0.001)。透析患者AMI期cTnT在4 d达峰值，整体持续时间23 d，均较肾功能正常患者延长(Z=-6.771、-9.592，均P＜0.001)；透析患者cTnT峰值与心电图缺血分级呈正相关(r=0.620，P＜0.001)。cTnT峰值与再发AMI(r=0.907，P＜0.001)、全因死亡(r=0.938，P＜0.001)呈正相关。 结论 诊断AMI时，透析患者需要更高的cTnT截断值；与肾功能正常患者相比，透析患者AMI期cTnT峰值更高、持续时间延长，但仍能良好反映AMI程度，并对再发AMI和死亡具有预判价值。
Objectives To investigate the variation of serum cardiac troponin T (cTnT) and its clinical value in hemodialysis patients with acute myocardial infarction (AMI). Methods We retrospectively studied the cTnT level and its variation trend in hemodialysis patients and normal renal function patients with AMI, to determine the relationship between cTnT level and the degree of AMI, and to predict the rate of recurrent AMI and mortality. Results During non-AMI stage, the baseline cTnT level was 147.25 (92.85, 236.65) ng/L in hemodialysis patients, significantly higher than that of 25.0 (15.0, 52.3) ng/L in normal renal function patients (Z=-11.595, P<0.001), and the cut-off value of cTnT for the diagnosis of AMI was 396.45ng/L. During AMI stage, the peak level of cTnT was 1938.0 ng/L in hemodialysis patients, higher than that of 1036.5ng/L in normal renal function patients (Z=-6.041, P＜0.001); cTnT reached a peak after 4.0 days, with an overall duration of 23.0 days in hemodialysis patients, longer than the values in normal renal function patients (Z=-6.771 and -9.592; P<0.001). Peak cTnT level was positively correlated with ECG ischemia grade in hemodialysis patients (r=0.620, P<0.001). Peak cTnT was positively correlated with AMI recurrence (r=0.907, P<0.001) and all-cause death (r=0.938, P<0.001). Conclusions Higher cTnT cutoff value is required for the diagnosis of AMI in hemodialysis patients. Compared with AMI in normal renal function patients, the peak level of cTnT is higher and lasts longer in AMI of hemodialysis patients, but the values can still be useful to reflect the degree of AMI and to predict AMI recurrence and mortality.
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