胱抑素C对冠心病的诊断价值及其影响因素

Diagnostic capability of Cystatin C to coronary heart disease and relevant influencing factors

目的 探讨血清胱抑素（Cystatin C）对冠心病的诊断能力及其影响因素.方法 纳入2011年1月至2011年6月我科以＂胸痛原因待查＂收入院并行冠状动脉造影检查的患者1120例,其中冠心病患者796例（CHD组）,非冠心病患者324例（非CHD组）,比较两组间临床参数差异.并对入选的796例CHD患者按年龄、高血压、高脂血症、糖尿病、吸烟、肥胖进行亚组分析,比较有传统冠心病危险因素的患者与无传统冠心病因素的患者之间Cystatin C水平的差异,用ROC曲线分析Cystatin C诊断冠心病的敏感性和特异性,并用logistic回归模型探讨Cystatin C的独立预测因素.结果 与非CHD组患者相比,CHD组CystatinC（1.10±0.31 vs.0.86±0.31,P=0.000）水平明显更高.在诊断冠心病患者时,Cystatin C为0.95mg/L时敏感度和特异性最高,分别为70.1%和 69.1%.合并糖尿病[相对危险度（OR）=1.733,95%CI：1.41~2.51,P=0.014]、男性（OR=2.906,95%CI：1.01~4.59,P=0.008）、eGFR降低（OR=0.652,95%CI：0.477~0.867,P＜0.001）、年龄（OR=1.801,95%CI：1.40~2.91,P=0.001）和收缩期高血压（OR=1.303,95%CI：1.02~1.53,P=0.002）是Cystatin C升高的独立危险因素.结论 Cystatin C升高用来诊断冠心病有较好的敏感度和特异性,糖尿病、男性、eGFR降低、年龄和收缩期高血压是Cystatin C升高的独立危险因素.

Objective To discuss the diagnostic capability of serum Cystatin C （ Cys C ） to coronary heart disease and relevant influencing factors. Methods The patients （ n=1120 ） with chest pain and accepted coronary angiography （ CAG ） were chosen from Jan. 2011 to Jun. 2011, among them 796 with coronary heart disease （ CHD group ） and 324 without CHD （ non-CHD group ） . The difference in clinical parameters was compared between two groups, and 796 CHD patients were further divided into subgroups and analyzed according to age, hypertension, hyperlipidemia, diabetes, smoking and obesity. The difference in Cys C level was compared between the patients with traditional risk factors of CHD and those without. The sensitivity and specificity of Cys C in CHD diagnosis were analyzed by using ROC curve, and independent predictors of Cys C was discussed by using Logistic regression model. Results Compared with non-CHD group, in CHD group the proportion of elderly patients （ 1〉65, 37.9% vs. 15.7%, P=0.000 ） , male patients （ 66.8% vs. 60.2%, P=0.034 ） , smoking patients （ 44.5% vs. 25.9%, P=0.000 ） , hypertensive patients （ 50.8% vs. 17.9%, P=0.000 ） , diabetic patients （ 42.2% vs. 31.5%, P=0.001 ） and obesity patients, and level of Cys C （ 1.10 ± 0.31 vs. 0.86 ± 0.31, P=0.000 ） all were higher significantly. When the level of Cys C was 0.95 rag/L, its sensitivity （ 70.1% ） and specificity （ 69.1% ） were the highest in the diagnosis of CHD. Complicated diabetes （OR=1.733, 95%C1=1.41-2.51, P=0.014）, male （OR=2.906, 95%CI=1.01-4.59, P=0.008 ） , decrease of glomerular filtration rate （ GFR, OR=0.652, 95%CI=0.477-0.867, P〈0.001 ） , age （ OR=1.801, 95%C1=1.40-2.91, P=O.001 ） and higher systolic blood pressure （ OR=1.303, 95%CI=1.02-1.53, P=0.002 ） were independent risk factors for elevated Cys C. Conclusion The increase of Cys C has higher sensitivity and specificity in the diagnosis of CHD, and diabetes, male, decrease of GFR, age and higher systolic blood pressure are independent risk factors for elevated Cys C.