血清胱抑素C和同型半胱氨酸在原发性高血压患者颈动脉粥样硬化早期诊断中的应用

Application of Serum cystatin C and Homocysteine on Early Evaluation of Carotid Artery Atherosclerosis in Patients with Primary Hypertension

目的：探讨血清胱抑素C和同型半胱氨酸在原发性高血压患者颈动脉粥样硬化早期诊断中的应用价值。方法：回顾分析2012年1月-2014年1月227例于本院门诊确诊为原发性高血压患者的临床资料。绘制受试者工作特征曲线分析血清胱抑素C和同型半胱氨酸对原发性高血压患者颈动脉粥样硬化的预测价值;分析血清胱抑素C和同型半胱氨酸与原发性高血压患者临床指标的相关性。结果：227例原发性高血压患者中诊断颈动脉粥样硬化42例。颈动脉粥样硬化组平均动脉压为（116.4±14.3）mm Hg,与非颈动脉粥样硬化组（78.3±13.5）mm Hg比较,有升高趋势,但差异无统计学意义（P=0.056）。颈动脉粥样硬化组收缩压为（167.2±16.3）mm Hg,显著高于非颈动脉粥样硬化组的（123.1±17.5）mm Hg,差异有统计学意义（P=0.002）。颈动脉粥样硬化组舒张压为（93.6±12.3）mm Hg,与非颈动脉粥样硬化组（76.2±8.5）mm Hg比较,差异无统计学意义（P=0.084）。颈动脉粥样硬化组血清胱抑素C为（1.4±0.2）mg/L,同型半胱氨酸为（22.8±5.2）μmol/L,均高于非颈动脉粥样硬化组的（0.8±0.1）mg/L、（13.2±4.9）μmol/L,差异均有统计学意义（P=0.016、0.028）。血清胱抑素C受试者工作特征曲线下面积为0.882（0.850~0.954）。当血清胱抑素C临界值为0.95 mg/L时,敏感性和特异性分别为88.3%和90.8%。同型半胱氨酸受试者工作特征曲线下面积为0.872（0.842~0.917）。当同型半胱氨酸临界值为16.9 mmol/L时,敏感性和特异性分别为87.1%和76.3%。血清胱抑素C、同型半胱氨酸与收缩压均呈正相关（r=0.762、0.715,P〈0.05）。为提高联合试验的敏感性,采用平行试验。当血清胱抑素C、同型半胱氨酸分别取临界值为0.95 mg/L和16.9 mmol/L时,联合敏感性为98.5%,联合特异性为69.3%。结论：血清胱抑素C与同型半胱氨酸可用于原发性高血压患者颈动脉粥样硬化早期诊断。当血清胱抑素C、同型半胱氨酸分别取临界值为0.95 mg/L和16.9 mmol/L时,联合敏感性为98.5%,联合特异性为69.3%。

Objective： To investigate value of serum cystatin C and homocysteine on early evaluation of carotid artery atherosclerosis （ CAA ） in patients with primary hypertension.Method ： The 227 patients with primary hypertension were enrolled from Jan 2012 to Jan 2014 retrospectively.ROC curve was done to analyze predictive value of serum cystatin C and homocysteine to carotid artery atherosclerosis in patients with primary hypertension. Correlation among serum cystatin C, homocysteine and clinical data in patients with primary hypertension were analyzed.Result： The 42 patients were diagnosed as carotid artery atherosclerosis.Mean arterial pressure of the CAA group was （116.4 ±14.3 ） mm Hg, and the no CAA group was （ 78.3 ±13.5 ） mm Hg, there was no statistically significant difference （ P=0.056 ） .SBP in the CAA group was significantly higher than that in the no CAA group[ （ 167.2 ＋ 16.3 ） ram Hg vs. （ 123.1 ± 17.5 ） mm Hg] （ P--0.O02 ） .DBP in the CAA group was （ 93.6 ± 12.3 ） mm Hg, there was no difference compared with the no CAA group （P=0.084） .Serum cystatin C and homocysteine in the CAA group were （ 1.4± 0.2 ） mg/L, （ 22.8 ± 5.2 ） μ mol/L, were significantly higher than those in the no CAA group[ （ 0.8 ± 0.1 ） rag/L, （ 13.2 ± 4.9 ） μmol/L] （ P=O.016, 0.028 ） .Area under ROC of serum cystatin C was 0.882 （ 95%C1：0.850-0.954 ） .With a cut-off value of 0.95 mg/L, serum cystatin C had a sensitivity of 88.3% and a specificity of 90.8%.Area under ROC of homocysteine was 0.872 （ 95%CI： 0.842-0.917 ） .With a cut-off value of 16.9 mmol/L, homocysteine had a sensitivity of 87.1% and a specificity of 76.3%.There was a positive correlation between serum cystatin C and systolic pressure （ r=0.762, P〈0.05 ） . There was a positive correlation between homocysteine and systolic pressure （ r=0.715, P〈0.05 ） .In order to improve sensitivity, parallel test was done. With a cut-off value of 0.95 mg/L in serum cystatin C and 16.9 mmol/L in homocysteine, parallel test had a sensitivity of 98.5% and a specificity of 69.3%.Coneluslon： Serum cystatin C and homocysteine could be helpful to in the early diagnosis to carotid artery atherosclerosis in patients with primary hypertension. With a cut-off value of 0.95 mg/L in serum cystatin C and 16.9 mmol/L in homocysteine, parallel test had a sensitivity of 98.5% and a specificity of 69.3%.