血清胱抑素C表达及尿液蛋白标记物水平在急性心力衰竭患者预后评估中的价值

The significance of expression levels of serum cystatin C and urine protein markers in prognosis evaluation for patients with acute heart failure

目的探讨血清胱抑素C(Cys-C)表达及尿液蛋白标记物水平在急性心力衰竭患者预后评估中的价值。方法选取因急性心力衰竭治疗的90例患者作为观察组,并且取健康体检的90例患者作为对照组,分别检测其Cys-C、脑钠肽(BNP)以及血肌酐和尿素氮、左心室射血分数(LVEF),分析对比不同心功能其分级和对照组的差异以及ACEI的干预性的影响效果,并且检测观察组在刚入院时,心力衰竭后24 h后其血Cys-C、肌酐(Scr)以及尿β2-微球蛋白(β2-MG)和白蛋白(ALb)的变化情况,并进行对比分析。结果观察组Cys-C的浓度明显高于对照组(P<0.05),而且随着心力衰竭患者的心功能的级别的增高而明显升高(P<0.05);观察组住院时血Scr和尿β2-MG、Alb水平与心力衰竭24 h比较,差异无统计学意义(P>0.05),而血Cys-C比较差异有统计学意义(P<0.01);高Cys-C患者其在6个月内的全因病死率、心血管事件的发生率以及再次入院概率均显著高于低Cys-C患者,差异有统计学意义(P<0.05);且心功能Ⅳ级患者肌酐水平明显高于对照组,差异有统计学意义(P<0.05)。结论 Cys-C的水平和心功能历程密切相关,其可反映出心力衰竭患者的早期肾脏功能的有关损伤情况,Cys-C水平对全因死亡以及心血管事件的预测意义重大,其明显优于其他的标志物。其被认为是评价心力衰竭患者早期肾损伤的一项快速、可靠的指标。

Objective To investigate the significance of expression levels of serum cystatin C（ Cys-C）,and urine protein markers in prognosis evaluation for patients with acute heart failure. Methods Ninety patients with acute heart failure who were admitted and treated in our hospitral from January 2014 to June 2015 were served as observation group,and the other 90 healthy subjects were served as control group. The levels of Cys- C,brain natriuretic peptide（ BNP）,serum creatinine（ Scr）,urea nitrogen,left ventricular ejection fraction（ LVEF） were detected in both groups. Moreover the changes of Cys-C,Scr,urinary β2 microglobulin（ β2-MG） and albumin（ Alb） on 24 hours after heart failure were observed and compared between two groups. Results The levels of Cys-C（ 1. 77 ± 0. 62） in observation group were significantly higher than those（ 0. 83 ± 0. 32） in control group（ P 〈0. 05）,moreover,which were gradually increased with the increase of cardiac function grade of patients（ P 〈0. 05）. There were no significant differences in the levels of Scr,β2-MG and Alb in observation group between those in hospitalization time and those on 24 hours after heart failure（ P 〈0. 05）,however,there were significant differences in the levels of Cys-C between the two time points（ P 〈0. 05）. The incidence of all- cause mortality,incidence of cardiovascular events and secondary hospitalization rate in patients with high levels of Cys-C were significantly higher than those of patients with low levels of Cys-C（ P 〈0. 05）. Furthermore the levels of Scr [（ 114 ± 61） μmol / L] in patients with cardiac function grade Ⅳ were significantly higher than those [（ 87 ± 10） μmol / L]in control group（ P 〈0. 05）. Conclusion The levels of Cys-C are closely correlated to heart function,which can reflect injury state of renal function of patients with acute heart failure at early period. The levels of Cys-C have important predictive significance for all-cause mortality,incidence of cardiovascular events,thus,which are regarded as a fast and reliable index in evaluating early renal injury of patients with heart failure.