血清半胱氨酸蛋白酶抑制剂C对急性心力衰竭的预后价值

Prognostic value of serum cystatin C in acute heart failure

目的探讨血清半胱氨酸蛋白酶抑制剂C(CysC)对急性心力衰竭(AHF)的预后价值。方法 2008-04-12-2011-04-25,从广东省人民医院急诊科招募符合入选标准的AHF患者372例作为研究对象。测定血清CysC等指标后进行随访,随访时主要记录死亡和因心血管事件而再次入院等预后指标。研究对象按血清CysC水平由低到高分为4组[Q1(≤1.06mg/L,n=94)、Q2(1.07～1.48mg/L,n=94)、Q3(1.49～1.85mg/L,n=92)、Q4(≥1.86mg/L,n=92)],根据随访结果,评价血清CysC对AHF的预后价值。结果随访的中位数为389d,病死率为25.5%,因心血管事件而再次入院率为34.1%。Kaplan-Meier生存曲线显示,随着血清CysC水平的升高,生存时间明显缩短,因心血管事件而再次入院的风险逐步增加。经Cox回归校正各种混杂因素后,Q2、Q3、Q4相对于Q1,死亡的危险比分别为1.88、2.42、3.71,差异具有统计学意义(P<0.01);因心血管事件而再次入院的危险比分别为1.57、2.50、3.06(P<0.01)。结论血清CysC升高是AHF不良预后的独立危险因子,可作为AHF患者不良临床事件危险分层的指标。

Objective To evaluate ihe prognostic prediction value of serum cystatin C （Cys C） in acute heart failure （AHF）. Methods Three hundred and seventy-two patients with AHF were recruited from emergency center of Guangdong People＇s Hospital between 12th April,2008 and 25th April,2011. At the time of admission,serum Cys C was examined and according to serum Cys C level, patients were divided into 4 groups： Q1（≤1. 06 mg/L, n=94）, Q2（1.07-1.48 mg/L, n：94）, Q3（1. 49-1. 85 mg/L, n=92）, Q4（≥1.86 mg/L, n=92）. The prognostic value of serum Cys C in AHF was evaluated based on all cause of death and readmission due to cardiovascular events during the follow-up time. Results The median of follow-up visit was 389 days. The case fatality rate was 25.5% while the readmission rate due to cardiovascular events was 34.1%. Kaplan-Meier survival curve showed that with the increase of serum Cys C level, the survival time was obviously decreased and the readmission risk due to cardiovascular events was gradually increased. Adjusting for confounding factors by Cox regression correction, the death risk ratio of Q2, Q3 and Q4 was 1.88,2.42 and 3. 71 compared with Q1（P〈0.01 respectively） and the readmission risk ratio due to cardiovascular events was 1.57,2.50 and 3.06 respectively （ P〈0.01 ）. Conclusion The increase of serum Cys C is the independent risk factor for AHF poor prognosis, which can be used as the risk stratification index for clinical adverse events in AHF patients.