目的 探讨非透析慢性肾脏病(chronic kidney disease,CKD)患者血红蛋白(Hemoglobin,Hgb)、肾小球滤过率(glomerular filtration rate,GFR)、血清肌钙蛋白T(cardiac troponin T,cTnT)的水平与肾性贫血(renal anemia,RA)的相关性。方法 收集中部战区总医院肾脏病科891例非透析CKD患者的住院资料,对入院时Hgb、cTnT及GFR等指标进行回顾性分析;根据Hgb水平将患者分为无、轻、中、重度贫血组,观察并分析各组GFR、cTnT水平;另外,根据GFR水平将患者分为CKD1-5期,观察并分析CKD各期Hgb水平以及Hgb低于90g/L的比例。结果 非透析CKD患者中,无、轻、中、重度贫血组的GFR(ml/min)水平分别为62.6(46.3,82.6)、37.9(25.5,51.4)、20.7(14.7,29.9)、16.4(13.0,27.4),不同贫血组的GFR水平经比较差异具有统计学意义(P<0.05);GFR水平随着贫血程度加重呈逐渐下降趋势;经Pearson相关性检验,GFR与Hgb存在正线性相关(R=0.653,P<0.05)。贫血分组中无、轻、中、重度组的cTnT(ng/ml)水平分别为0.010(0.006,0.015)、0.016(0.011,0.028)、0.028(0.016,0.045)、0.036(0.021,0.046);不同贫血组cTnT水平比较,差异有统计学意义(P<0.05);cTnT水平随着贫血程度加重呈逐渐上升趋势;经Pearson相关性检验,cTnT与Hgb存在负线性相关(R=-0.300,P<0.05)。随着CKD分期增加,Hgb平均水平呈逐渐下降趋势,Hgb低于90g/L的比例呈逐渐上升趋势。结论 积极纠正非透析CKD患者的贫血状况,可改善心肌受损状态,对控制肾脏病进展有一定作用。
Abstract
Objective To explore the relationship between cardiac troponin T (cTnT),glomerular filtration rate (GFR),and renal anemia (RA) respectively by analyzing levels of three indexes among hemoglobin (Hgb), GFR and cTnT in non-dialysis patients with chronic kidney disease (CKD). Methods The levels of Hgb, cTnT and GFR of 891 inpatients with non-dialysis CKD in our hospital were analyzed. According to Hgb level, patients were divided into four anemia groups of no, mild, moderate and severe, and levels of GFR and cTnT were observed respectively in each group. According to GFR level,patients were divided into CKD1-5 stages,and the Hgb level at each stage of CKD and the proportion of Hgb level below 90g/L were observed and analyzed. Results In non-dialysis patients, the GFR (ml/min) levels were 62.6(46.3,82.6), 37.9(25.5,51.4), 20.7(14.7,29.9), 16.4(13.0,27.4) in no, mild, moderate and severe anemia group, respectively. The GFR levels of different anemia groups showed significant differences with statistical significance(P<0.05). The GFR levels decreased gradually with the aggravation of anemia. Pearson-test showed a positive linear relationship between GFR and Hgb (R=0.653, P<0.05).The levels of cTnT (ng/ml) were 0.010(0.006,0.015), 0.016(0.011,0.028),0.028 (0.016,0.045), 0.036(0.021,0.046) in no, mild, moderate and severe groups, respectively. CTnT level increased gradually with the aggravation of anemia. Pearson-test showed a negative linear relationship between cTnT and Hgb (R=-0.300, P< 0.05).With increased CKD staging, the average level of Hgb gradually decreased, and the proportion of Hgb below 90 g/L gradually increased. Conclusions Actively ameliorating anemia in non-dialysis patients with CKD can delay renal function progression and improve myocardial status.
关键词
肾性贫血 /
肌钙蛋白T /
血红蛋白 /
肾小球滤过率 /
肾脏病
Key words
renal anemia /
cardiac troponin T /
hemoglobin /
glomerular filtration rate /
kidney disease
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参考文献
[1] 中华医学会肾脏病学分会肾性贫血诊断和治疗共识专家组. 肾性贫血诊断与治疗中国专家共识(2018修订版)[J]. 中华肾脏病杂志,2018,34(11):860.
[2] 范 鹏, 裘淼涵, 赵惟超,等. 贫血对急性冠脉综合征患者长期临床预后影响[J]. 临床军医杂志,2020, 48(5):7-10.
[3] 葛均波, 徐永健,王 辰.内科学[M]. 9版.北京:人民卫生出版社,2018:123.
[4] Levey A S, Jong P E, Coresh J, et al. The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report[J]. Kidney Int, 2011,80(1):17-28.
[5] Higashiura M, Ohya M, Tanaka Y, et al. Correlation between haemoglobin level and type of erythropoiesis-stimulating agent at initiation of haemodialysis[J]. INT J Clin pharm-NET, 2020, 42(2): 635-641.
[6] 李 欣,李国慧,张 俊,等.高原地区慢性肾脏病3a～5D期患者贫血状况的横断面研究[J].中国实用内科杂志,2019,39(10):879-885.
[7] Loutradis C, Skodra A, Georgianos P, et al. Diabetes mellitus increases the prevalence of anemia in patients with chronic kidney disease: A nested case-control study[J]. World J Nephr, 2016, 5(4): 358.
[8] Yi S W, Moon S J, Yi J J. Low-normal hemoglobin levels and anemia are associated with increased risk of end-stage renal disease in general populations: a prospective cohort study[J]. Plos one, 2019, 14(4): e0215920.
[9] Tanaka K, Watanabe T, Takeuchi A, et al. Cardiovascular events and death in Japanese patients with chronic kidney disease[J]. Kidney int, 2017, 91(1): 227-234.
[10] Vestergaard S V, Heide J U, Haalen H, et al. Risk of anemia in patients with newly identified chronic kidney disease-a population-based cohort study[J]. Clin Epidemiol, 2020, 12: 953.
[11] Portolés J, Gorriz J L, Rubio E, et al. The development of anemia is associated to poor prognosis in NKF/KDOQI stage 3 chronic kidney disease[J]. BMC Nephr, 2013, 14(1): 1-9.
[12] Tsuruya K, Yoshida H, Suehiro T, et al. Erythropoiesis-stimulating agent slows the progression of chronic kidney disease: a possibility of a direct action of erythropoietin[J]. Renal Failure, 2016, 38(3): 390-396.
[13] 朱冬燕,陈 向,曹亚南,等.慢性肾脏病骨矿物质代谢紊乱FGF23的血管钙化机制[J].武警医学,2018,29(4):409-412.
[14] Kozinski M, Krintus M, Kubica J, et al. High-sensitivity cardiac troponin assays: from improved analytical performance to enhanced risk stratification[J]. Crit Rev Clin Lab Sci, 2017, 54(3): 143-172.
[15] Morandini M, Berto A. The organizational impact of high-sensitivity troponin (hs-cTn) in the laboratory network for acute coronary syndrome (ACS)[J]. Italian J Labora Med, 2017,13(3-4):187-193.
[16] Hof D, Eckardstein A. High-sensitivity troponin assays in clinical diagnostics of acute coronary syndrome[J].Calcium EF Hand Superfa, 2019,40: 645-662.
[17] Park K C, Gaze D C, Collinson P O, et al. Cardiac troponins: from myocardial infarction to chronic disease[J]. Cardiovasc Res, 2017, 113(14): 1708-1718.
[18] 潘德璋,袁巧萌,任星峰,等.慢性肾脏病1～5期心肌肌钙蛋白T参考范围的确立[J].华南国防医学杂志,2021,35(9):642-646.
[19] Baker P, Leckie T, Harrington D, et al. Exercise-induced cardiac troponin elevation: An update on the evidence, mechanism and implications[J]. IJC Heart & Vasculature, 2019, 22: 181-186.
基金
中部战区总医院育英计划项目(ZZYFH202120)
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