胱抑素C及肾小球滤过率对冠心病的评估价值

The clinical value of cystatin C in serum and glomerular filtration rate in coronary disease

目的:探讨血清胱抑素C(Cys C)及肾小球滤过率(GFR)与冠状动脉(冠脉)病变程度的相关性。方法:回顾性分析243例疑诊为冠心病的患者,均进行冠脉造影(CAG),依据CAG结果分组,冠心病171例,其中单支病变组77例,双支病变组53例,多支病变组41例;72例造影正常者为对照组。所有入选者常规测定Cys C,根据Cys C将患者分为3组:Cys C<0.97mg/L组(低水平组,80例),0.97mg/L≤Cys C<1.21mg/L组(中水平组,81例)及Cys C≥1.21mg/L组(高水平组,82例)。根据简化MDRD公式估算GFR。结果:①与对照组比较,冠心病各组血清Cys C水平明显升高,GFR水平明显降低,且随冠状动脉病变支数的增加血清Cys C升高,GFR降低,差异有统计学意义(P<0.05);②Cys C高水平组冠心病及冠脉双支、多支病变比例均较Cys C低水平及中水平组高,冠脉正常比例则低于Cys C低、中水平组,组间比较差异具有统计学意义(P<0.05);③Cys C与年龄(r=0.586)、血肌酐(Cr)(r=0.651)呈正相关(P<0.05),Cys C与HDL-C(r=-0.182)和GFR(r=-0.638)呈负相关(P<0.05);④Logistic多元回归分析结果显示年龄、高血压病史、糖尿病病史、TC、Cys C、GFR是冠心病变的危险因素(P<0.05);⑤Cys C、GFR、Cr诊断冠心病的ROC曲线下面积分别为0.696、0.581、0.468,提示Cys C较GFR及Cr预测冠心病的价值更大(P<0.05)。结论:Cys C及GFR水平与冠心病的病变程度有密切关系,是识别冠心病高危患者的一个有益的临床标记物。

Objective：To observe the relationship among level of cystatin C（Cys C）in serum,glomerular filtration rate（GFR）and the severity of coronary artery.Method：Retrospective analysis the data of 243patients underwent coronary angiography with clinically suspected coronary heart disease（CHD）.Among them,171 patients with CHD were divided into three subgroups：77cases with single-vessel lesion,53cases with doublevessel lesions and 41cases with triple-vessel lesions;while 72cases with normal coronary arteries were selected as control group.Serum levels of Cys C were detected by immune turbidimetry.The subjects were divided into three groups according to Cys c level in tertiles：Cys C0.97mg/L（low level group,80cases）,0.97mg/L≤Cys C 1.21mg/L（horizontal level group,81cases）and Cys C≥1.21mg/L（high level group,82cases）.GFR was estimated by simplified MDRD equation.Result：①Compared with the control group,the serum level of Cys C was significantly increased and the level of GFR was significantly decreased in the CHD group（P0.05）.The more coronary lesions was,the higher serum level of Cys C and the lower level of GFR.The differences had statistical significances（P0.05）.②In the high level Cys C group,CHD and double-vessel lesions,multiple-vessel lesions proportions were higher than the low and horizontal Cys C level groups,while the normal proportions of coronary artery were lower than the Cys C low and horizontal groups,with difference statistically significant between the groups（P0.05）.③The serum level of Cys C was positively correlated with age（r=0.586）and serum creatinine（r=0.651）（P0.05）and was negatively correlated with HDL-C（r=-0.182）and GFR（r=-0.638）（P0.05）.④Logistic regression results showed that age,history of hypertension,history of DM,total cholesterol levels,Cys C levels,GFR were risk factors for CHD（P0.05）.⑤The area under ROC curve of diagnosing CHD for Cys C,GFR,serum creatinine were 0.696,0.581,0.468respectively,which indicated that Cys C was significantly better predictor than GFR and creatinine.Conclusion：High serum Cys C levels and low level of GFR are associated with severity of CHD.They may have potential clinical value as markers for identification of high risk CHD patients.