血清胱抑素C与介入治疗急性冠状动脉综合征预后关系

Prognostic Value of Plasma Cystatin C for Patients with Acute Coronary Syndrome Underwent Percutaneous Coronary Intervention

目的探讨急性冠脉综合征(ACS)患者血清胱抑素C(Cys-C)水平与冠状动脉介入(PCI)术后主要不良心血管事件(MACE)的相关性。方法选择接受PCI治疗的ACS患者312例,入院后12h内测定Cys-C水平完善各项检查,随访1年,按有无MACE进行分组,并将Cys-C水平按四分位法分为Q1(<0.81mg/L),Q2(0.81～0.92mg/L),Q3(0.93～1.10mg/L),和Q4(≥1.11mg/L)4组,进行相关统计学分析。结果与非事件组比较,事件组的Cys-C水平显著增高(P<0.05);在预测1年心血管事件的中,Cys-C、cTnI、hsCRP及CK-MB的ROC的曲线下面积分别为0.781、0.620、0.702、0.636;其中Cys-C最有预测价值。Kaplan-Meier生存分析示Q4、Q3、Q2的1年MACE事件发生率依次高于Q1组(P<0.001)。多元COX回归分析显示,Cys-C、LVEF、cTnI是远期发生心血管事件的独立预测因子。结论 Cys-C可以预测接受PCI急性冠状动脉综合征患者的远期预后,可用于ACS的危险分层。

Objective To study the correlation between serum cystatin - C （Cys - C） level and major adverse cardiovascular events （MACE） in patients with acute cardiovascular syndrome （ACS） after percutaneous coronary intervention （ PCI）. Methods Clinical data about 312 ACS patients who underwent percutaneous coronary intervention （PCI） were retrospectively analyzed. The patients were divided into MACE group and non - MACE group. Cys - C levels were compared between the two groups. The patients were then divided into 4 groups according to their serum Cys - C level （ Q1 〈 0. 81mg/L; Q2 = 0. 81 - 0. 92mg/L; Q3 = 0.93 - 1.10rag/L; Q4 ≥l. 1 lmg/L）. Risk factors for MACE were analyzed by Cox regression analysis. Results The serum Cys - C level was higher in MACE group than in non - MACE group（ P 〈 0. 05 ）. The area under curve of Cys - C, cTnI, hsCRP and CK - MB to predict MACE were O. 781,0. 620,0. 702 and O. 636 respectively. Kaplan - Meier analysis showed that the occurrence of MACE in the Q2, Q3, and Q4 groups was higher than in the Q1 group （ P 〈 0. 001 ）. Multivariate COX regression indicated that LVEF, cTnI（ hazad ratio = 3. 004 ,P = 0. 022） and cystatin C levels （ hazad ratio = 2.185 ,P = 0. 016） were independently associated with the occurrence of MACE. Conclusion The serum cystatinC level is an independent predictor of MACE in patients with ACS underwent PCI.