Whether distributions and prognostic values of high-sensitivity cardiac troponin (hs-cTn) T and I are different across normoglycemic, prediabetic, and diabetic populations is unknown. 10127 adult participants from the National Health and Nutrition Examination Survey 1999–2004 with determined glycemic status and measurement of at least one of hs-cTn assays were included, from whom healthy participants and presumably healthy diabetic and prediabetic participants were selected to investigate pure impacts of glycemic status on distributions of hs-cTn. The nonparametric method and bootstrapping were used to derive the 99th upper reference limits of hs-cTn and 95% CI. Participants with available follow-up and hs-cTn concentrations of all 4 assays were included in prognostic analyses. Associations of hs-cTn with all-cause and cardiac-specific mortality were modeled by Cox proportional hazard regression under the complex survey design. The incremental value of hs-cTn to an established risk score in predicting cardiac-specific mortality was assessed by the 10-year area under time-dependent receiver operating characteristic curve (AUC) using the Fine-Grey competing risk model. Among 9714 participants included in prognostic analyses, 5946 (61.2%) were normoglycemic, 2172 (22.4%) prediabetic, and 1596 (16.4%) diabetic. Hyperglycemic populations were older than the normoglycemic population but sex and race/ethnicity were similar. During the median follow-up of 16.8 years, hs-cTnT and hs-cTnI were independently associated with all-cause and cardiac-specific mortality across glycemic status. In the diabetic population, adjusted hazard ratios per 1-standard deviation increase of log-transformed hs-cTnT and hs-cTnI (Abbott) concentrations were 1.77 (95% CI 1.48–2.12; P < .001) and 1.83 (95% CI 1.33–2.53; P < .001), respectively, regarding cardiac-specific mortality. In the diabetic but not the normoglycemic population, adding either hs-cTnT (difference in AUC: 0.062; 95% CI 0.038–0.086; P < 0.001) or hs-cTnI (Abbott) (difference in AUC: 0.071; 95% CI 0.046–0.097; P < 0.001) would significantly increase the discriminative ability of the risk score; AUC of the score combined with hs-cTnT would be further improved by incorporating hs-cTnI (0.018; 95%CI 0.006–0.029; P = 0.002). The 99th percentile of hs-cTnT of the presumably healthy diabetic population was higher than the healthy population and had no overlap in 95% CIs, however, for hs-cTnI 99th percentiles of the two populations were very close and 95% CIs extensively overlapped. Hs-cTnT and hs-cTnI demonstrated consistent prognostic associations across glycemic status but incremental predictive values in hyperglycemic populations only. The susceptibility of hs-cTnT 99th percentiles to diabetes plus the additive value of hs-cTnI to hs-cTnT in diabetic cardiovascular risk stratification suggested hs-cTnI and hs-cTnT may be differentially associated with glycemic status, but further research is needed to illustrate the interaction between hyperglycemia and hs-cTn.

中文翻译：

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高敏心肌肌钙蛋白 T 和 I 在不同血糖状态下的分布和预后价值：一项基于人群的研究

高敏心肌肌钙蛋白 (hs-cTn) T 和 I 的分布和预后值在血糖正常、糖尿病前期和糖尿病人群中是否不同尚不清楚。10127 名来自 1999-2004 年国家健康和营养检查调查的成年参与者，已确定血糖状态并测量了至少一项 hs-cTn 测定，从中选择健康参与者和可能健康的糖尿病和糖尿病前期参与者来调查血糖状态对 hs-cTn 分布的影响。使用非参数方法和自举法得出 hs-cTn 的第 99 个参考上限和 95% CI。所有 4 项检测中具有可用随访和 hs-cTn 浓度的参与者均纳入预后分析。hs-cTn 与全因死亡率和心脏特异性死亡率的关联是通过复杂调查设计下的 Cox 比例风险回归建模的。使用 Fine-Grey 竞争风险模型，通过时间依赖性受试者工作特征曲线 (AUC) 下的 10 年面积来评估 hs-cTn 对预测心脏特异性死亡率的既定风险评分的增量值。在纳入预后分析的 9714 名参与者中，5946 名 (61.2%) 血糖正常，2172 名 (22.4%) 处于糖尿病前期，1596 名 (16.4%) 患有糖尿病。高血糖人群比血糖正常人群年龄更大，但性别和种族/民族相似。在 16.8 年的中位随访期间，hs-cTnT 和 hs-cTnI 与不同血糖状态下的全因死亡率和心脏特异性死亡率独立相关。在糖尿病人群中，对数转换 hs-cTnT 和 hs-cTnI (Abbott) 浓度每增加 1 个标准差，调整后的风险比分别为 1.77 (95% CI 1.48–2.12；P < .001) 和 1.83 (95% CI)关于心脏特异性死亡率，分别为 1.33–2.53；P < .001）。在糖尿病而非血糖正常人群中，添加 hs-cTnT（AUC 差异：0.062；95% CI 0.038–0.086；P < 0.001）或 hs-cTnI (Abbott)（AUC 差异：0.071；95% CI 0.046 –0.097；P < 0.001）将显着提高风险评分的辨别能力；通过纳入 hs-cTnI，评分与 hs-cTnT 相结合的 AUC 将进一步提高（0.018；95%CI 0.006–0.029；P = 0.002）。假定健康的糖尿病人群的 hs-cTnT 第 99 个百分位数高于健康人群，并且在 95% CI 中没有重叠，然而，对于 hs-cTnI，两个人群的第 99 个百分位数非常接近，并且 95% CI 广泛重叠。Hs-cTnT 和 hs-cTnI 在不同血糖状态之间表现出一致的预后关联，但仅在高血糖人群中具有增量预测值。hs-cTnT 99% 对糖尿病的易感性加上 hs-cTnI 与 hs-cTnT 在糖尿病心血管风险分层中的附加值表明 hs-cTnI 和 hs-cTnT 可能与血糖状态存在差异相关，