半胱氨酸蛋白酶抑制剂C与急性冠状动脉综合征近期预后的相关性研究

Study on the correlation of cystatin C concentration with short term prognosis of acute coronary syndrome

目的研究半胱氨酸蛋白酶抑制剂c（CysC）与急性冠状动脉综合征（ACS）患者近期预后的关系。方法选择ACS患者386例，其中sT抬高型ACS（STE—ACS）患者212例、非sT抬高型ACS（NSTE—ACS）患者174例。检测入院24h内ACS患者血清B型钠尿肽（BNP）、高敏C反应蛋白（hs—CRP）、CysC、心肌肌钙蛋白I（cTnI）浓度。将CysC按百分位数问距分组，采用秩和检验比较BNP、hs—CRP、年龄、体重在不同组间的差异以及STE—ACS和NSTE—ACS患者中的CysC浓度差异。采用，检验比较高血压、糖尿病、高血脂、吸烟在不同组间的分布差异。随访入选病例住院期间和出院后18个月内心血管事件的发生情况，比较不同组别人群心血管事件累计发生率，绘制ACS患者心血管事件累计发生率对时间Kaplan—Meier曲线以及CysC预测近期心血管不良事件发生的受试者工作特征（ROC）曲线。结果根据血清CysC百分位数间距将ACS患者分为〈0．69mg／L组（96例）、0．69～〈0．86mg／L组（97例）、0．86～〈1．03mg／L组（98例）和≥1．03mg／L组（95例）。随着CysC百分位数间距的增高，年龄、BNP、hs—CRP水平以及高血压、糖尿病、高血脂的分布率不断增高；体重、吸烟在各组中的分布率没有明显差异。STE—ACS组与NSTE—ACS组间血清CysC浓度差异无统计学意义（P〉0．05）。18个月内由低到高的不同CysC浓度组对应的心血管事件累计发生率依次增高，分别为6．3％、7．2％、9．2％、18．9％；Kaplan—Meier曲线显示，≥1．03mg／L组与〈0．69mg／L组之间差异有统计学意义（P〈0．05）。CysC预测近期心血管不良事件发生的ROC曲线下面积为0．754。结论CysC水平与心血管风险因子BNP、hs—CRP、年龄、高血压、糖尿病、高血脂呈正相关，对预测ACS患者近期不良心血管事件发生具有一定意义，预测性与ACS的类型无关。

Objective To study the relationship of eystatin C （ Cys C） concentration with short term prognosis in acute coronary syndrome （ACS） patients. Methods A total of 386 ACS patients were enrolled, including 212 patients with ST elevation ACS （STE-ACS） and 174 patients with non-ST elevation ACS （NSTE-ACS）. Serum B-type natriuretie peptide （BNP）, high sensitive C reactive protein （hs-CRP）, Cys C and cardiac troponin I （eTnI） were determined within 24h after admission. Serum Cys C was classified according to percentile intervals. Rank-sum test was used to compare the levels of BNP, hs-CRP, age and weight in the different groups and the differences of Cys C concentrations in the STE-ACS and NSTE-ACS groups. X2 test was used to compare the distribution differences of hypertension, diabetes melfitus, high cholesterol and smoking in the different groups. The cardiovascular events of the selected patients during hospitalization and after discharge were followed up. The cumulative incidence rates of cardiovascular events were compared among the different groups, Kaplan-Meier curves of cumulative incidence rates of cardiovascular events to time were drawn, and receiver operating characteristic （ROC） curve was drawn to assess Cys C predictive adverse outcome in patients with ACS. Results According to Cys C concentration percentile intervals, the ACS patients were classified into 〈 0.69 mg/L group （ 96 patients ） , 0.69- 〈 0.86 mg/L group （97 patients ） , 0.86- 〈 1.03 mg/L group （98 patients） and t〉1.03 mg/L group （95 patients）. The age,BNP and hs-CRP also increased in the different groups, as well as the distributions of hypertension, diabetes mellitus and high cholesterol. Weight and smoking distributions in each group had no significant difference. Cys C concentration in STE-ACS group had no statistical significance with that in NSTE-ACS （ P 〉 0.05 ）. The cumulative incidence rates of cardiovascular events inthe different groups were 6.3% , 7.2% , 9.2% and 18.9% from low-concentration Cys C to high-concentration Cys C respectively, but there was statistical significance between〉 1.03 mg/L group and 〈 0.69 mg/L group, according to Kaplan-Meier curves （P 〈 0. 05 ）. The area under ROC curve predicting the risk of adverse outcome was 0. 754. Conclusions Cys C concentration is positively correlated with BNP, hs-CRP, age, hypertension, diabetes mellitus and high cholesterol, and it contributes particularly in predicting the adverse outcome in patients with ACS, with no interaction by the type of ACS.