胱抑素C对慢性心力衰竭患者早期肾脏损害的预测价值

The predictive value of serum cystatin C in early impairment of renal function in patients with chronic heart failure

目的探讨血清胱抑素C（CysC）与心功能分级及早期肾脏损害的关系。方法 83例慢性心力衰竭（CHF）患者均符合NYHA心功能分级标准,心功能Ⅱ~Ⅳ级;25例心功能I级,心力衰竭病史≥6个月;89例性别、年龄、居住地等与心衰患者匹配的健康者为对照组。采用颗粒增强免疫比浊法测定血清CysC的浓度,并测定血肌酐（Scr）、尿微量白蛋白（UMA）、左室射血分数（LVEF）及左心室舒张末内径（LVEDD）。结果心功能I级者血清CysC水平较对照组显著升高。随着NYHA心功能分级级别增高,血清CysC水平明显升高。不同病因心衰组相互比较,血清CysC浓度差异无统计学意义。血清CysC与LVEF呈显著负相关,与LVEDD呈显著正相关。UMA水平与血清CysC水平呈显著正相关,心衰患者血清CysC的改变较Scr的改变出现迅速。结论血清CysC水平对预测CHF患者早期肾脏损害及评估心衰预后具有一定的临床意义。

Objective To assess the relation of serum cystatin C（CysC） with cardiac function grading and early renal impairment.Methods Totally 83 patients with chronic heart failure（CHF） were measured according to NYHA cardiac function classification criteria,with heart function class Ⅱ-Ⅳ.There were 25 cases of cardiac function class Ⅰ with the history of heart failure ≥6 months.In control group,89 healthy subjects matched those CHF patients in gender,age and place of residence.Particle enhanced immunoturbidimetry was used to detect serum CysC concentration,serum creatinine（Scr）,urinary micro-albumin（UMA）,left ventricle ejection fraction（LVEF） and left ventricle end-diastolic diameter（LVEDD）.Results The level of serum CysC in heart function class I group was increased significantly than that in the control group（P〈0.05）.It increased with the higher class of NYHA heart functional classification（class Ⅳ cardiac function class〉 Ⅲ class 〉Ⅱ,respectively）.There were no significant differences in CysC level between heart failure groups with different causes.CysC levels had significantly negative correlation with LVEF but significantly positive correlation between CysC and LVEDD.It was positively correlated with UMA level.The change of CysC level was more rapid than that of serum Scr.Conclusion The level of serum CysC can predict early renal damage and provides prognostic information for clinical outcomes in CHF patients.