背景当代指南推荐使用动脉粥样硬化性心血管疾病筛查工具指导一级预防。这些分数的表现在中度至晚期慢性肾病患者中并不为人所知，特别是结合临床可用的心脏生物标志物，包括N末端脑利钠肽前体和高敏肌钙蛋白T（hsTnT）。方法和结果我们研究了1027名来自慢性肾功能不全队列的参与者，他们没有自我报告的动脉粥样硬化性心血管疾病，他们在招募时没有服用阿司匹林或他汀类药物。弗雷明汉风险评分,集合队列方程，N末端脑利钠肽前体,和hsTnT在基线测量。结果包括致命性和非致命性心肌梗塞，中风,和心脏死亡。我们计算了每个风险评分和心脏生物标志物单独和组合的10倍交叉验证的HarrellC指数。对于Framingham风险评分，区分动脉粥样硬化性心血管疾病的C指数（95％CI）为0.72（0.67，0.77），和0.72(0.67，0.76)的集合队列方程。HsTnT对每个风险评分都有相当的歧视，并改善了每个的辨别(Framingham0.029，95%CI0.003，0.055的变化；集合队列方程0.027，95%CI0.002，0.052的变化)。与风险评分相比，N末端脑利钠肽前体的辨别能力较差，并且没有显着改善其辨别能力（Framingham0.009，95％CI-0.001，0.018；集合队列方程0.011，95％CI-0.001，0.024的变化）。结论Framingham风险评分和集合队列方程显示了慢性肾脏病患者动脉粥样硬化性心血管疾病的中度区分。HsTnT,但不是N末端脑钠肽前体，总体上提高了他们的歧视。直到慢性肾脏疾病特异性动脉粥样硬化性心血管疾病风险评分可以制定，如何将hsTnT纳入现有临床风险评分可能值得考虑.
Background Contemporary guidelines recommend using atherosclerotic cardiovascular disease screening tools to guide primary prevention. The performance of these scores is not well known in patients with moderate to advanced chronic kidney disease, particularly in combination with clinically available cardiac biomarkers including N-terminal pro-brain-type natriuretic peptide and high-sensitivity troponin T (hsTnT). Methods and Results We studied 1027 participants from the Chronic Renal Insufficiency Cohort without self-reported atherosclerotic cardiovascular disease who were not taking aspirin or statins at enrollment. Framingham Risk Score, Pooled Cohort Equation, N-terminal pro-brain-type natriuretic peptide, and hsTnT were measured at baseline. Outcomes included fatal and nonfatal myocardial infarction, stroke, and cardiac death. We calculated 10-fold cross-validated Harrell\'s C-indices for each risk score and cardiac biomarker alone and in combination. The C-index (95% CI) for discrimination of atherosclerotic cardiovascular disease was 0.72 (0.67, 0.77) for the Framingham Risk Score, and 0.72 (0.67, 0.76) for the Pooled Cohort Equation. HsTnT had comparable discrimination to each risk score, and improved the discrimination of each (change in Framingham 0.029, 95% CI 0.003, 0.055; change in Pooled Cohort Equation 0.027, 95% CI 0.002, 0.052). N-terminal pro-brain-type natriuretic peptide had poorer discrimination than the risk scores and did not significantly improve their discrimination (change in Framingham 0.009, 95% CI -0.001, 0.018; change in Pooled Cohort Equation 0.011, 95% CI -0.001, 0.024). Conclusions The Framingham Risk Score and Pooled Cohort Equation demonstrated moderate discrimination for atherosclerotic cardiovascular disease in patients with chronic kidney disease. HsTnT, but not N-terminal pro-brain-type natriuretic peptide, improved their discrimination overall. Until chronic kidney disease-specific atherosclerotic cardiovascular disease risk scores can be developed, it may be worth considering how to incorporate hsTnT into existing clinical risk scores.
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