血清NGAL和Cys-C对老年冠心病患者早期肾损害的诊断价值

Diagnostic value of serum NGAL and Cys-C for early renal damage in aged patients with chronic heart failure of coronary heart disease

目的：探讨老年冠心病患者血清中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和胱抑素 C （Cys-C）水平与心肾功能关系及其对早期肾损害的诊断价值。方法：选择84例老年冠心病患者，NYHA心功能Ⅰ～Ⅳ级（Ⅰ级组30例、II级组28例、Ⅲ～Ⅳ级组26例），另选择31例老年健康者为健康对照组。测定患者血清 N末端 B型利钠肽原（NT-proBNP）、NGAL和Cys-C等指标，并分析血清 NGAL和 Cys-C水平与 NT-proBNP和估计肾小球滤过率（eGFR）的相关性。应用受试者操作工作特征（ROC）曲线评价血清 NGAL和Cys-C诊断肾功能不全的准确性。结果：健康对照组，NYHAⅠ、II、Ⅲ～Ⅳ级组血清 NGAL [（36.96±21.23）μg/L比（87.80±61.40）μg/L比（141.21±92.96）μg/L比（198.15±98.46）μg/L]和Cys-C [（0.75±0.64）mg/L比（1.40±1.88）mg/L比（2.33±2.03）mg/L比（3.45±1.81）mg/L]水平随着心衰程度加重而升高，以 NYHAⅢ～Ⅳ级组升高最为明显，4组血清 NGAL水平两两比较均有显著性差异（P＜0.01），而血清 Cys-C水平除在 NYHAI级组与健康对照组比较无显著性差异（P＞0.05）外，其余各组两两比较差异均有统计学意义（P＜0.05或＜0.01）。Pearson相关分析显示血清 NGAL和Cys-C水平与 NT-proBNP均呈正相关（r值分别为0.842和0.718，P均＜0.01），与 eGFR均呈负相关（r值分别为-0.689和-0.448，P均＜0.01），且血清NGAL水平与NT-proBNP和eGFR的相关性更密切。血清 NGAL和Cys-C诊断肾功能不全的 ROC曲线下面积分别为0.884和0.744。结论：老年冠心病慢性心力衰竭患者血清 NGAL和Cys-C水平与心肾功能有较好的相关性，是诊断早期肾损害敏感而准确的指标。

Objective：To explore the relationship among serum neutrophil gelatinase associated lipocalin （NGAL）, cystatin C （Cys-C） levels and cardiac, renal function;and diagnostic value of NGAL and Cys-C for early renal damage in aged patients With coronary heart disease （CHD）.Methods：According to NYHA cardiac function classi-fication,a total of 84 aged CHD patients Were divided into class I group （n=30）,class Ⅱ group （n=28）and classⅢ-Ⅳ group （n=26）.Another 31 aged healthy objects Were selected as healthy control group.Serum N terminal pro B-type natriuretic peptide （NT-proBNP）,NGAL and Cys-C etc. levels Were measured,and the correlation a-mong serum NGAL,Cys-C levels and cardiac function,estimated glomerular filtration rate （eGFR）Were analyzed. The accuracy of serum NGAL and Cys-C diagnosing renal insufficiency Was evaluated by receiver operator character-istic curve （ROC）.Results：Along With NYHA class increased,there Were significant increase in serum levels of NGAL [（36.96±21.23）μg/L vs.（87.80±61.40）μg/L vs.（141.21±92.96）μg/L vs.（198.15±98.46）μg/L] and Cys-C [（0.75±0.64）mg/L vs.（1.40±1.88）mg/L vs.（2.33±2.03）mg/L vs.（3.45±1.81）mg/L]in healthy control group,NYHA I,Ⅱ,Ⅲ-Ⅳ groups,and they Were highest in NYHA class Ⅲ-Ⅳ group,there Was significant difference in serum NGAL level betWeen any tWo groups among the four groups （P〈0.01）,and so Was serum Cys-C level （P〈0.05 or 〈0.01）except healthy control group and NYHA class I group （P〉0.05）.＆amp;nbsp;Pearson correlation analysis indicated that serum NGAL and Cys-C levels Were positively correlated With NT-proBNP （r=0.842,0.718,P〈0.01 both）,and negatively correlated With eGFR （r=-0.689,-0.448,P〈0.01 both）, and serum NGAL level had closer correlation With NT-proBNP and eGFR.Area under ROC of serum NGAL and Cys-C Were 0.884 and 0.744 respectively in diagnosing renal insufficiency.Conclusion：Serum NGAL and Cys-C lev-els have good correlation With cardiac and renal function in aged CHD patients,Which are sensitive and accurate in-dexes for diagnosing early renal damage.