血清胱抑素C水平对血肌酐正常急性心肌梗死患者的预后价值探讨

Study on evaluating the prognostic value of the plasma cystatin C in patients with acute myocardial infarction and normal serum creatinine

目的评价血清胱抑素C(Cys-C)水平对急性心肌梗死(AMI)患者近期和远期预后的预测价值。方法选取血肌酐(Scr)正常(58～110μmol/L)的AMI住院患者174例,根据发病24h内血清Cys-C的中位数水平分为A组(Cys-C≤1.018mg/L)和B组(Cys-C>1.018mg/L)。记录住院及随访两年期间的心脏不良事件(MACE)发生情况。结果 (1)B组患者住院期间的心血管死亡及心力衰竭发生率(6.9%和25.3%)明显高于A组(1.1%和12.6%),差异有统计学意义(P<0.05);随访两年期间B组患者的心血管死亡及心力衰竭发生率(12.6%和23%)均明显高于A组(3.4%和10.3%),差异有统计学意义(P<0.05);两组住院期间均无再次AMI发生。随访期间再次AMI事件无统计学差异。(2)Logistic回归分析显示,血清Cys-C水平是MACE发生的独立危险因素(OR=1.038,P=0.01)。(3)ROC曲线分析,Cys-C预测MACE事件的敏感性及特异性高于肾功能指标Scr,其预测MACE临界值为0.996mg/L。结论心肌梗死急性期血清Cys-C水平可作为评价肾功能正常AMI患者预后的指标之一。

Objective To evaluate the short and long-term prognostic value of the plasma cystatin C(Cys-C)concentrations in patients with acute myocardial infarction and normal serum creatinine(Scr).Methods According to the changing of Cys-C median level within 24 hours of chest pain symptom onset,174 chosen patients with acute myocardial infarction and normal Scr(58-110 μmol/L)were classified into 2 groups:Group A(Cys-C≤1.018 mg/L)and Group B(Cys-C>1.018 mg/L).The cases of major adverse cardiac events(MACE)were recorded during in-hospital and the follow-up periods of two years.Results During in-hospital patients with cardiovascular death and heart failure in group B(6.9% and 25.3%)were significantly more than those in group A(1.1% and 12.6%),P<0.05;And in the follow-up period of two years,patients with cardiovascular death and heart failure in group B(12.6% and 23%)were also obviously more than patients in group A(3.4% and 10.3%),P<0.05.There was no significant difference about recurrent myocardial infarction during the follow-up period.Meanwhile,both groups had no recurrent myocardial infarction during in-hospital period.Logistic regression analysis showed that the Cys-C level was the independent risk factor for MACE(OR=1.038,P=0.001).On the basis of ROC curve analysis,Cys-C was stronger than kidney function index Scr in predicting the sensibility and specificity of cardiovascular events,and it calculated 0.996 mg/L as the cutoff level of MACE.Conclusions Cys-C concentrations may be one of criteria of evaluating prognostic value in patients with acute myocardial infarction and normal renal function.