血清胱抑素C对慢性心衰患者早期肾功能损害的诊断价值

Clinical Research on Early Renal Damage in Chronic Heart Failure Patients

目的探讨血清胱抑素C(Cys-C)对慢性心力衰竭患者早期肾功能损害的诊断价值。方法选择慢性心力衰竭(CHF)患者55例(无原发肾脏损害)设为A组,并按NYHA心功能分级标准(Ⅰ～Ⅳ级)将其分为不同亚组;选择无CHF的心脏病患者40例设为B组;另选32例健康志愿者作为空白对照设为C组。测定各组血清Cys-C、血清肌酐(SCr)、脑利钠肽(pro-BNP)、24h尿蛋白(UMA)和β2微球蛋白(β2-MG)水平,测量左室射血分数(LVEF),进行统计学分析。结果 A组与B、C组比较,CHF患者血Cys-C浓度明显高于对照组(P<0.01),其中心功能Ⅲ、Ⅳ级的血清浓度高于Ⅰ～Ⅱ级(P<0.05);血Cys-C与pro-BNP、UMA呈显著正相关(r=0.613,P=0.014,r=0.56,P=0.029),与LVEF呈负相关(r=-0.55,P=0.038)。与SCr不相关(P=0.61)。结论血清Cys-C水平可能是反映心衰严重程度的标志之一。其对慢性心衰患者肾功能的评估优于SCr,测定血清Cys-C浓度对发现心力衰竭患者早期肾损害及评估预后具有一定临床意义。

Objective To investigate changes of Serum Cystatin C（Cys-C）in patients with chronic heart failue and diagnose early impairment of renal function.Methods 127 patients with heart disease in the Cardiology Department of our hospital from Feb 2011 to Oct 2011 were chosen and divided into three groups.Patients in Group A（n=55）had chronic heart failure（no primary renal disease）,Group B（n=40）patients without heart failure,and Group C（n=32）were healthy volunteers as controls.Cys-C,serum creatinine（SCr）,pro-BNP、UMA and serum β2-microglobulin（β2-MG）,LVEF levels of the three groups were measured respectively,and statistical analysis was done as well.Results Compared with those of Group B and C,serum Cys-C concentrations of Group A were significantly increased（P0.01）,and its heart function Ⅲ~Ⅳ grade was higher than the serum concentrations ofⅠ~Ⅱlevel（P0.05）.Cys-C was negatively correlated with left ventricular ejection fraction（r=-0.55,P0.01）and positively correlated with pro-BNP、UMA（r=0.613,P=0.014,r=0.56,P=0.029）.Conclusion Cys-C concentration could reflect early renal damage of patients with CHF,and be an early indicator of deteriorating heart failure.It also might be an effective indicator to assess the prognosis of CHF risk.