血清胱抑素C与肌酐在评估75岁以上老年慢性心衰患者预后中的价值

Prognostic value of cystatin C and creatinine in chronic heart failure in patients aged over 75 years

目的比较血清胱抑素C(cystatin-C,Cys-C)和肌酐(creatinine,Cr)对评估老年慢性心脏功能衰竭(chronic heart failure,CHF)患者预后的价值。方法收集我院心内科及老年科2010-2012年住院确诊为CHF的75岁以上老年患者183例。抽取静脉血,检测所有患者血清中Cys-C和Cr的表达情况。随访3年,记录患者3年内生存情况。Logistic回归分析Cys-C和Cr以及其他危险因素与老年CHF患者3年死亡率的相关性。ROC曲线分析比较Cys-C和Cr在老年CHF患者预后评估中的价值,最后进一步用统计学方法分析Cys-C和Cr二者联合检测对老年CHF患者预后评估的价值。结果随访3年后,74名患者死亡,占整体人数的40.44%;相比于生存组,死亡组患者血清中Cys-C和Cr升高(P<0.05);多因素回归结果显示,年龄(OR=1.11,95%CI=1.04~1.19)、收缩压值(OR=1.11,95%CI=1.04~1.19)、BNP(OR=1.11,95%CI=1.04~1.19)、LVEF(OR=1.11,95%CI=1.04~1.19)、Cr(OR=1.11,95%CI=1.04~1.19)、Cys-C(OR=1.11,95%CI=1.04~1.19)都是老年CHF患者死亡的独立危险因素。ROC曲线分析结果显示,Cys-C和Cr的AUC值分别为0.71(95%CI,0.64~0.78)、0.65(95%CI,0.58~0.72),Cys-C优于Cr(P<0.001);Cys-C&Cr联合检测时,AUC值为0.73(95%CI,0.66~0.79)。结论 Cys-C在评估老年CHF患者预后中优于Cr,两者联合检测可以进一步提升对老年CHF患者预后评估的敏感性和特异性。

Objective To compare the prognostic value of cystatin-C （Cys-C） and creatinine （Cr） in chronic heart failure （CHF） in old people. Methods We recruited 183 old patients （〉 75 years） diagnosed with CHF hospitalized at the Department of Cardiology and the Department of Geriatrics of our hospital from 2010 to 2012. Venous blood was withdrawn to detect the expressions of Cys-C and Cr. After three-year follow-up, the patients＇ three-year survival was recorded. Logistic regression model was used to examine the relationship of Cys-C, Cr and other risk factors with the CHF patients＇ mortality. ROC curve was used to compare the prognostic value of Cys-C and Cr in CHF in old people and statistical method was adopted to analyze the combined use of Cys-C and Cr for determining their value in evaluating CHF prognosis. Results At the end of the follow-up, 74 （40.44%） patients died. Serum cys-C and Cr levels of the patients in death group increased compared with those in survival group （P〈 0.05）. Multivariate logistic regression showed that age （OR=l. 11, 95% CI=1.04-1. t9）, SBP （OR=1.06, 95% CI=1.01-1.10）, LVEF （OR=0.89, 95% CI=0.82-0.95）, BNP （OR=4.74, 95% CI=1.77-12.69）, creatinine （OR=2.04, 95% CI=1.03-4.08）, and Cys-C （OR=2.97, 95% CI=1.44-6.12） were the independent risk factors for the prognosis of CHF. ROC analysis showed that Cys-C was superior to creatinine in AUC value （0.71 vs. 0.65; 95% CI, 0.64-0.78, 95% CI, 0.58-0.72） （P〈0.001）. The AUC value of Cys-C and Cr in combination was 0. 73 （95% CI, 0.66 - 0.79）. Conclusion Cys-C is a stronger predictor of the prognosis of CHF patients than creatinine and the combination of the two can increase the sensitivity and specificity in evaluating the prognosis of patients with CHF.