血清胱抑素C与非ST段抬高性急性冠状动脉综合征患者GRACE评分相关性及预后的关系

Relationship between cystatin C,GRACE score and prognosis in patients with non-ST-elevation acute coronary syndrome

目的探讨非ST段抬高性急性冠状动脉综合症(NST-ACS)患者血清胱抑素C(Cys C)水平与危险评分相关性及与预后的关系。方法入选NST-ACS患者212例,并将同期入院疑似冠心病而经冠脉造影检测排除的60例患者作为对照组,检测纳入研究患者血清Cys C水平,并收集超敏C反应蛋白(hs-CRP)、计算中性粒细胞淋巴细胞比值(NLR)吸烟史、既往史等临床资料,根据GRACE评分系统计算NSTE-ACS入院及出院6个月GRACE评分,记录NSTE-ACS住院期间及出院后6个月主要不良心血管事件(MACE)发生情况。结果 NSTE-ACS组患者血清Cys C、hs-CRP及NLR水平较高(P<0.05)。NSTE-ACS组Cys C入院GRACE评分、出院6个月GRACE评分、年龄、Cr、hs-CRP、NLR呈正相关(分别为r=0.322,r=0.394,r=0.430,r=0.617,r=0.404,r=0.323,P均<0.05)。单因素Logistic回归显示:Cys C(OR=8.271,P=0.00,95%CI 2.670-25.624)、年龄(OR=1.050,P=0.00,95%可信区间为1.025-1.076)、TG(OR=0.647,P=0.02,95%可信区间为0.448-0.936)是MACE的发生危险因素。多因素Logistic回归显示:Cys C(OR=5.403,P=0.03,95%可信区间为1.203-24.253)是MACE发生的危险因素。结论血清Cys-C对NSTE-ACS患者早期危险分层具有重要的临床指导价值,且可作为预测NSTE-ACS患者预后的生物标记物。

Objective To study the relationship between serum cystatin C（Cys-C）,Global registry of acute coronary events（GRACE） score and prognosis in patients with non-ST-elevation acute coronary syndrome（NSTE-ACS）. Methods 212 patients with NSTE-ACS and 60 individuals as a control group were included in the study. Cys-C and inflammation markers [high-sensitivity C-reactive protein（hs-CRP） and neutrophil to lymphocyte ratio（NLR）] were measured. The patients with NSTE-ACS were followed-up for six months,and the major adverse cardiac events（MACE） were observed. GRACE score was calculated according to GRACE risk score system. Results Serum Cys-C levels,NLR and hs-CRP were significantly higher in patients with NSTE-ACS（all P0.05）. In patients with NSTE-ACS,Serum Cys-C levels were correlated positively with age,creatinine,hs-CRP levels and NLR（r=0.322,r=0.394,r=0.430,r=0.617,respectively,all P0.05）. Serum Cys-C levels were also correlated positively with admission GRACE score and six months discharge GRACE score（r=0.322 and r=0.394,all P0.05）. Single factor logistic regression analysis indicated that Cys-C [odds ratio（OR） 8.271,95% confidence interval（CI） 2.670-25.624,P =0.00],age（OR1.050,95% CI 1.025-1.076,P=0.00）,TG（OR 0.647,95%CI 0.448-0.936,P=0.02） were the independent predictors of MACE. Multiple factors Logistic regression analysis indicated that Serum Cys-C levels（OR 5.403,95%CI 1.203-24.253,P P0.05） were the independent predictors of MACE. Conclusion Our findings suggest that serum Cys-C level may be a biomarker in patients with NSTE-ACS,it was an independent predictor of MACE and could be used for early risk stratification.