射血分数正常性心力衰竭患者胱抑素C与心功能和预后的关系研究

The relationship among Cys C and heart function and prognosis in heart failure patients with preserved ejection fraction

目的研究射血分数正常性心力衰竭(HFPEF)患者血清胱抑素C(Cys C)水平与心功能和预后的关系,探讨其临床应用价值。方法纳入HFPEF患者189例,按Cys C水平分为Cys C正常组(Cys C<1.04 mmol/L)和Cys C异常组(Cys C≥1.04 mmol/L),比较2组患者心功能的差异,随访1年,通过Log-rank检验和生存曲线比较2组患者联合终点事件(全因死亡和因心力衰竭再次入院)的差异,通过ROC曲线分析Cys C水平对终点事件的预测价值。结果 (1)与Cys C正常组比较,异常组心脏舒张功能较差(E/A:0.71±0.09 vs 0.81±0.25),NT-proBNP水平较高[(3248±1534)pg/ml vs(2513±1203)pg/ml],心功能分级较高(NYHAⅢ/Ⅳ分级:67.8%vs 46.1%),差异均有统计学意义(P<0.01)。(2)随访1年,与Cys C正常组比较,Cys C异常组联合终点事件发生率较高:全因病死率(24.1%vs 16.7%,P<0.05),因心力衰竭再入院率(47.1%vs 26.5%,P<0.01);Cys C水平对联合终点预测敏感度和特异度分别为84.5%、77.3%,临界值为1.23 mmol/L。结论 Cys C是预测HFPEF患者1年内临床事件的良好指标,可用于患者危险分层,指导治疗。

Objective To investigate the relationship between serum cystatin C （Cys C） levels and both of heart function and prognosis in patients with heart failure with preserved ejection fraction （ HFPEF）, and evaluate its clinical value. Methods 189 patients with HFPEF were enrolled, they were divided into normal group（ Cys C 〈 1.04 retool/L） and abnormal group（ Cys C ≥ 1.04 mmol/L） based on serum Cys C level, compared the differences of cardiac function on base, then follow up 1 year, compared those differences of combined end point （ all cause death and re-admitted for heart failure） with Log-rank test and survival curve, by ROC curve analysis Cys C levels on the predictive value of endpoint events. Results Compared with the normal group, the patients in abnormal group had worse cardiac function： poor diastolic function （E/A： 0.71 ± 0.09 vs. 0.81 ± 0.25 ）, higher levels of NT-proBNP [ （ 3248 ± 1534 ） pg/ml vs. （ 2513 ± 1203 ） pg/ml） ], higher cardiac functional classification （NYHA Ⅲ/Ⅳ class： 67.8% vs. 46.1% ）, the differences were statistically significant （ P 〈 0.01 ）. During follow up 1 year, the combined end point event rates were higher in abnormal group： all caused death （24.1% vs. 16.7%, P 〈0.05）, re-admitted for heart failure （47.1% vs. 26.5%, P 〈0.01 ） ; the sensitivity and specificity which Cys C levels predicted the combined end point were 84.5% and 77.3% respectively, and the cut point was 1.23 mmol/L. Conclusion Cys C is a reliable predicted indicator of clinical events for HFPEF patients, and Cys C can be used for risk stratification and guide treatment.