老年慢性心力衰竭患者胱抑素C和纤维蛋白原水平的变化趋势及意义

Change trend and significance of cystatin C and fibrinogen levels in elderly patients with chronic heart failure

目的探讨不同心功能分级老年慢性心力衰竭(CHF)患者血清胱抑素C(Cys C)及纤维蛋白原(Fg)水平的变化趋势及意义。方法选取2013年1月至2014年1月石河子大学第一附属医院收治的住院老年CHF患者191例纳入观察组,其中美国纽约心脏病协会(NYHA)心功能分级Ⅱ级69例,Ⅲ级58例,Ⅳ级64例;另选取同期体检健康者50例纳入健康对照组;比较各组血清Cys C、Fg水平及超声心动图各项指标,并分析其与NYHA心功能分级的相关性。结果健康对照组、观察组不同心功能分级患者左室射血分数(EF)、左室舒张末期内径(LVEDD)、左心室后壁(LVPW)厚度、室间隔(IVS)厚度、Fg及Cys C水平比较,差异均有统计学意义(P<0.05);且血清Cys C、Fg水平与心功能NYHA分级均呈正相关(r分别为0.255、0.165,P<0.05);血清Cys C水平与LVEDD、IVS厚度均呈正相关(r分别为0.136、0.166,P<0.05);Logistic多元回归分析显示,血清Cys C与Fg为老年CHF的危险因素,而三酰甘油、胆固醇为保护因素(均P<0.05)。结论血清Cys C、Fg水平与CHF的严重程度密切相关,且Cys C还可能参与心室重构过程,Cys C与Fg联合检测可作为判定CHF严重程度的参考指标。

Objective To investigate the change trend of serum cystatin C（Cys C）and fibrinogen（Fg）levels and its clinical significance in the elderly patients with different NYHA grades of chronic heart failure（CHF）.Methods 191 inpatients with CHF in the First Affiliated Hospital of School of Medicine,Shihezi University were included in the observation group,including 69 cases of NYHA grade Ⅱ,58 cases of NYHA grade Ⅲ,64 cases of NYHA gradeⅣ;contemporaneous 50 individuals with physical examination were selected as the healthy control group.The detection results of Cys C and Fg levels,and indexes of Doppler echocardiography were compared among 4groups.The correlation between the Cys C and Fg levels with the NYHA classification was analyzed.Results Fg,Cys C,EF,LVEDD,LVPW,IVS were statistically different between different cardiac function grades of the observation group and the healthy control group（P〈0.05）;the Cys C and Fg levels were positively correlated with the cardiac function grade（r= 0.255,0.165 respectively,P〈0.05）;the Cys C level was positively correlated with LVEDD,IVS（r=0.136,0.166 respectively,P〈0.05）;the Logistic regression analysis showed that Cys C and Fg were the risk factors of elderly CHF,while triglycerides and cholesterol were the protective factors（P〈0.05）.Conclusion The serum Cys C and Fg levels are closely related with the severity of chronic heart failure,moreover Cys C may also be involved in the process of ventricular remodeling,the combined detection of Cys C and Fg levels may serve as the reference index in the judgment of severity of CHF.