血清胱抑素C表达水平在评估心力衰竭预后中的价值

Prognostic value of serum cystain C in patients with heart failure

目的探讨胱抑素C（ Cys C）在心力衰竭患者的表达水平和对预后的作用，以及短期（＜6个月）应用血管紧张素转换酶抑制剂（ ACEI ）对心力衰竭患者Cys C的影响。方法选取2011年11月至2012年9月间因心力衰竭入院的患者81例（心衰组）并取健康体检者81例作为对照组，分别检测Cys C、脑钠肽（BNP）、血肌酐、尿素氮、左室射血分数（LVEF），分析不同心功能分级与对照组之间的差异，及Cys C与LVEF、收缩压、舒张压、BNP的相关性，以及ACEI干预的影响，并进行了6个月随访。本研究采用SPSS17．0统计学软件进行分析，多组比较采用单因素方差分析，组间比较采用t检验，率的比较采用χ2检验或Fisher’精确检验。结果心衰组患者的Cys C浓度明显高于对照组[（1．77±0．63）比（0．83±0．33）mg/L，Z＝-9．648， P＜0．01]，且随心功能级别增高而显著升高；高Cys C组患者的6个月内全因病死率，主要心血管事件发生率，6个月内再入院率都明显高于低Cys C组[39．4％（13/33）比6．3％（3/48），P＜0．01；66．7％（22/33）比22．9％（11/48），P＜0．01；69．7％（23/33）比14．6％（7/48），P＜0．01]；血清Cys C与LVEF、收缩压、舒张压、尿素氮均有较好的相关性；心功能 IV 级的患者的肌酐水平比对照组高[（114±62）μmol/L 比（87±11）μmol/L， F＝10．643， P＜0．05]。心衰组应用ACEI治疗6个月后尿素氮、肌酐、血清Cys C水平较治疗前均有所下降，但只有血清Cys C的水平差异有统计学意义（P＜0．01）。结论（1）Cys C水平与心功能程度相关，可反映心力衰竭患者早期肾脏功能的受损情况，Cys C对全因死亡及主要心血管事件方面的预测价值优于其他标志物。

Objectives To investigate the prognostic value of Cystatin C in patients with heart failure, and apply the changes of serum Cystatin C level with angiotensin-converting enzyme inhibitor therapy for short-term （6 months）.Method Eighty-one cases of patients with heart failure who were admitted to China-Japan Union Hospital of Jilin University between November , 2011 and September , 2012 and 81 cases of healthy were enrolled in this study .All of them had measurements of Cystatin C , brain natriuretic peptide （BNP）, serum creatinine （Scr）, blood urea nitrogen （BUN）, and left ventricular ejection fraction （LVEF）, and the effects of ACEI intervention .All enrolled patients received an average of 6 months follow-up.The chi square test and Fisher ’ exact were used and analyzed by SPSS 17.0 software.Results Compared with the control group, Cystatin C concentration elevated in heart failure group （（1.77 ±0.63） vs （0.83 ±0.33） mg/L, Z=-9.648, P 〈0.01）,and increased with NYHA functional classes , Cystatin C concentration was significantly higher.However, compared with the control group , there was statistically significant in serum creatinine level in patients with NYHA IV （（114 ±62） vs （87 ±11）μmol/L, F =10.643, P 〈0.05）. Compared with lower Cystatin C patients , higher Cystatin C patients ’ all-cause death within six months rate , the incidence of major cardiovascular events , re-hospitalization rate within six months were significantly higher （39.4%（13/33） vs 6.3%（3/48）, P〈0.01.66.7%（22/33） vs 22.9%（11/48）, P〈0.01.69.7%（23/33） vs 14.6%（7/48）, P〈0.01）.Serum Cystatin C level has good correlation with LVEF ,systolic blood＆amp;nbsp;pressure , diastolic blood pressure and BNP .After 6 months treatment with ACEI , blood urea nitrogen , creatinine, serum Cystatin C level are decreased than before treatment .Among of them,only the concentration of serum Cystatin C difference is statistically significant （P〈0.01）.Conclusion （1）Cystatin C level elevated in patients with heart faliure ,and it is associated with the degree of heart function .Cystatin C level can reflect the impairment of early renal function in patients with heart failure .Cystatin C has better predictive value for all-cause mortality and major cardiovascular events than other markers .（2）Serum Cystatin C level is more sensitivity than urea nitrogen and creatinine concentration on renal function .