检测慢性心力衰竭患者尿液肾损伤分子-1及血清胱抑素C的临床意义

Significance of urine kidney injury molecule-1 and Cystatin C in patients with chronic heart failure

目的 探讨慢性心力衰竭患者尿液肾损伤分子-1（KIM-1）及血清胱抑素C（Cys C）的水平与心功能、肾功能之间的关系.方法 选择我院2013年1～10月在心血管内科住院的慢性心力衰竭患者60例,对照组为我院体检中心的健康体检者30名.所有入选者均行左室射血分数（LVEF）、肾小球滤过率（eGFR）、血浆N端B型脑钠肽前体（NT-proBNP）、KIM-1和Cys C检测.结果 与健康对照组相比,慢性心力衰竭组患者尿KIM-1及Cys C水平显著升高（P＜0.05）.将患者按LVEF≥40％和LVEF＜40％分组发现,LVEF＜40％组患者尿KIM-1及Cys C水平显著高于LVEF≥40％组（P＜0.05）,均显著高于健康对照组（P＜0.05）.尿KIM-1及Cys C水平呈正相关（r=0.42,P＜0.05）.另外研究发现,尿KIM-1水平与NT-pro-BNP水平呈正相关（r=0.45,P＜0.05）,与LVEF呈负相关（r=0.38,P＜0.05）.慢性心力衰竭组患者尿KIM-1水平与Scr无显著相关性（r=0.11,P＞0.05）,与eGFR无显著相关性（r=-0.13,P＞0.05）.尿KIM-1水平与ACR水平呈正相关（r=0.42,P＜0.05）.结论 肾功能正常的慢性心力衰竭患者尿KIM-1及Cys C水平显著升高,与心功能和心衰的严重程度密切相关,提示慢性心力衰竭患者存在肾小管损伤,并且尿KIM-1及Cys C水平可以间接反映慢性心肾综合征（CRS）的严重程度.

Objective To detect the level of urine kidney injury molecule-1 （KIM-1） and Cystatin C in patients with chronic heart failure, （CHF） and research the correlation of heart function and renal function. Methods 60 chronic heart failure cases were collected from January to October 2013 in cardiovascular department of our hospital. The control group was 30 healthy subjects in our hospital medical center. All patients underwent left ventricular ejection fraction （LVEF）, glomerular filtration rate, plasma N terminal B type natriuretic peptide precursor, Urinary albumin excretion rate, kidney injury molecule-1 and Cystatin C examination. Results Com- pared with healthy controls, the level of KIM-1 and Cystatin C were increased significantly inpatients with chronic heart failure （P〈0.05）. We divided patients into two group with EFt〉40% and EF〈40% and found that the level of urine KIM-1 patients in LVEF〈40% group was significantly higher than that of LVEF ≥ 40% group, they were significantly higher than that of healthy eontrol group. The level of urinary KIM-1 was positive correlated with NT- pro-BNP（r=0.45, P〈0.05）, negatively correlated with LVEF（r=0.38, P〈0.05）. There was no significant correla- tion between the levels of urine KIM-1 and Scr（r=0.11, P〉0.05） or eGFR（r=-0.13, P〉0.05） with chronic heart failure patients. At the same time, there was a significant positive correlation with the level of urine KIM-1 andACR （r=0.42, P〈0.05）. Conclusion In CHF patients with normal renal function, the level of KIM-1 and Cys- tatin C increased significantly and closely related to the severity of heart function and heart failure. Renal tubular damage and Glomerular injury maybe exist the early stage of CHF and level of urine KIM-1 and Cystatin C can in- directly reflect the severity chronic CRS.