非ST段抬高性急性冠脉综合征患者胱抑素C与GRACE评分的研究

Research on Cystatin C and GRACE risk score of patients with Non-ST segment elevation acute coronary syndrome

目的:探讨非ST段抬高性急性冠脉综合征(NSTE-ACS)患者血浆胱抑素C(Cys C)水平与全球急性冠状动脉事件注册(GRACE)评分之间的关系。方法:共有155例NSTE-ACS患者符合入选标准,分为非ST段抬高性心肌梗死(NSTEMI)组和不稳定性心绞痛(UA)组,收集基本临床资料,进行GRACE评分,同时次日清晨空腹采集肘静脉血,检测Cys C,与87例非冠心病患者进行对照比较。结果:与对照组比较,NSTE-ACS患者Cys C,GRACE评分均出现显著性升高,差异有统计学意义(P<0.05);Cys C水平随GRACE危险程度增加,出现显著性升高,差异有统计学意义(P<0.05);相关性分析显示,NSTEACS患者Cys C与GRACE评分呈显著正相关(r=0.549,P<0.01);多元线性回归分析,胱抑素C与年龄、肌酐、HDL密切相关。血清胱抑素C最佳临界点为1.185 mg/L,此时的AUC面积最大(0.841),灵敏度为69.7%,特异度为89.3%。结论:Cys C可作为反应动脉粥样硬化程度较好的指标,有助于预测冠心病的发生发展;在NSTE-ACS患者中联合运用对早期危险分层、评估预后及诊疗方案的选择有重要临床价值。

Objective： To evaluate the relationship between Cystatin C （CysC） and the global registry of acute coronary events （GRACE） score of patients with non-ST segment elevation acute coronary syndrome （NSTE-ACS）. Methods： 155 patients with NSTE-ACS who made a definite diagnosis were selected and divided into non-ST segment elevation myocardial infarction （NSTEMI） group and unstable angina pectoris （UA） group. After admission and collection of clinical data, GRACE score was evaluated; at the meantime, through venous blood sampling, CysC of NSTE-ACS group was detected and compared with that of 87 patients without coronary heart disease （Control group）. Results： In NSTE-ACS patients, compared with the control group, the level of serum CysC and the GRACE scores were significantly increasing; with the level of GRACE risks increasing, the level of serum CysC were significantly increased, the difference of which was statistically significant （P〈0.05）. The results of correlation analysis show that CysC had a positive correlation with GRACE scores （r=0.549,P〈0.01 ）; while multivariate linear regression analysis demonstrates that age, creatinine and HDL are the main factors which influence the level of serum CysC in patients with NSTE-ACS. The optimal cut-off point of CysC was 1.185 mg/L, and the area under curve （AUC） was the biggest （0.841）, while the sensitivity was 69.7%, and the specificity was 89.3%. Conclusions： The level of CysC can be used as a better indicator of extent of coronary atherosclerosis, as the dynamic changes can help predict the occurrence and development of coronary heart disease. In NSTE-ACS patients, combining it with other indicators has the important clinical value on early risk stratification, evaluation of prognosis and treatment options.