2型糖尿病肌钙蛋白Ⅰ升高的预测因素及预后价值

 目的 通过检测2型糖尿病(type 2 diabetes mellitus,T2DM)患者中肌钙蛋白I(cardiac troponin I,cTnI)的水平,探讨2型糖尿病患者中cTnI升高的比例、影响因素及与不良预后的关系。方法 选择我院就诊的2型糖尿病患者552例,检测每位患者入院时cTnI水平。收集所有患者基线资料,并分析与患者cTnI水平相关的心血管危险因素。随访所有患者2年内的主要不良心脏事件发生情况(major adverse cardiac events,MACE),包括心力衰竭(heart Failure,HF)、心肌梗死(myocardial infarction,MI)和心血管死亡(cardiovascular mortality)。结果 552例2型糖尿病患者,90.0%可检测到cTnI水平,70例(12.7%)cTnI水平高于健康人群的99百分位值。logistic多因素回归分析证实伴随冠状动脉疾病(coronary artery disease,CAD)(OR:2.93,95% CI:1.33~6.44,P<0.01)及eGFR水平较低(OR:0.97,95% CI:0.95~0.99,P=0.02)是cTnI水平升高的预测因素。所有患者随访期间共发生43例MACE事件,其中HF18例, MI 11例及心血管死亡14例。多因素回归分析证实,cTnI水平升高与MACE(HR:2.86,95% CI:1.16~7.04,P=0.02)及HF(HR:3.87,95% CI:1.22~15.19,P=0.03)发生风险增加有关。结论 2型糖尿病患者中可见到cTnI水平升高,并与患者年龄、性别、肾功能不全等相关,此外,cTnI水平升高与2型糖尿病患者MACE事件风险增加有关。

Determinants and prognostic value of troponin-I for adverse outcomes in patients with type 2 diabetes mellitus

Objective To find out about the prevalence, determinants, and prognostic implications of cardiac troponin I (cTnI) elevations in patients with Type 2 diabetes mellitus (T2DM). Methods scTnI was measured in stored, frozen serum samples from 552 subjects with T2DM enrolled in our hospital at baseline. Results were analyzed in relation to baseline characteristics and conventional cardiovascular risk factors. All these patients were followed up for 2 years for any incidence of MACE, including heart failure (HF), myocardial infarction (MI) and cardiovascular mortality. Results 90.0 % of these patients had detectable cTnI at baseline and 70 of them (12.7 % of the total) had values above the 99th percentile for healthy controls. Levels at baseline were associated with concomitant CAD (OR: 2.93, 95% CI: 1.33-6.44, P<0.01) and lower eGFR (OR: 0.97, 95% CI: 0.95-0.99, P=0.02). A total of 43 cases of MACE occurred, including HF (n=18), MI (n=11) and cardiovascular mortality (n=14). Multivariate analysis also revealed that an elevated cTnI was an independent predictor of MACE (HR: 2.86, 95% CI: 1.16-7.04, P=0.02) and HF (HR: 3.87, 95% CI: 1.22-15.19, P=0.03). Conclusions Elevations of cTnI above the 99th percentile were frequent in T2DM patients. cTnI levels appear to be associated with concomitant CAD and lower eGFR. Also, elevated cTnI in patients with T2DM is associated with increased risks of MACE.