血清胱抑素C在慢性心力衰竭早期诊断中的临床意义

Clinical significance of serum cystatin C in early diagnosis of chronic heart failure

目的分析血清胱抑素(Cys C)对慢性心力衰竭(CHF)早期诊断的意义。方法 106例住院患者,将患者分为对照组(35例)和病例组(71例)。对照组为既无器质性心脏病又无心力衰竭症状的患者,病例组包括既有器质性心脏病和(或)心力衰竭症状的患者。对两组进行基线分析,采用Logistic单因素和多因素分析,确定CHF的独立危险因素。进行受试者工作特征曲线(ROC)分析确定Cys C作为CHF早期的评价指标的最佳界值。结果病例组患者的Cys C水平(1.14±0.37)mg/L,明显高于对照组患者的(0.87±0.27)mg/L,差异有统计学意义(P<0.05)。相关性分析发现,在单因素分析中Cys C在CHF早期诊断的OR值为17.701,说明Cys C与CHF早期密切相关。调整相关影响因素后进行多因素Logistic回归分析,发现Cys C无论是作为连续变量还是二分类变量,其都是CHF早期的重要危险因素(OR值分别为7.553、9.776),提示Cys C可能是CHF早期的独立危险因素。通过ROC曲线获得Cys C作为CHF早期诊断评价指标的最佳界点值是0.8850 mg/L,灵敏度为77.5%,特异度为71.4%,结果说明此界值有较好的灵敏度和特异度。结论 Cys C是CHF的独立危险因素,对CHF早期诊断具有重要临床意义。

Objective To analyze significance of serum cystatin C （Cys C） in early diagnosis of chronic heart failure （CHF）. Methods A total of 106 hospitalized patients were randomly divided into control group （35 cases） and case group （71 cases）. The control group contained patients without organic heart disease and heart failure symptoms, and the case group contained patients with organic heart disease and （or） heart failure symptoms. Both groups received baseline analysis. Univariate and multivariate Logistic analysis were applied to determine independent risk factor for CHF. Receiver operating characteristic （ROC） curve was used to analyze and determine the best cut-off value by Cys C as early evaluation index for CHF. Results The case group had obviously higher Cys C level as （1.14 ± 0.37） mg/L than （0.87 ± 0.27） mg/L in the control group, and their difference had statistical significance （P〈0.05）. Correlation analysis showed OR value by Cys C as 17.701 in univariate analysis for early diagnosis of CHF, and it showed close correlation between Cys C and early CHF. Multivariate Logistic analysis after regulation of related influencing factors showed Cys C, acting as continuous variable or binary variable, as the important risk factor for early CHF （OR value respectively as 7.553, 9.776）. Cys C was suggested as the independent risk factor for early CHF. ROC curve showed that best cut-off value as 0.8850 mg/L by Cys C as early evaluation index for CHF, along with sensitivity as 77.5% and specificity as 71.4%. The cut-off value contained good sensitivity and specificity. Conclusion As the independent risk factor for CHF, Cys C shows important clinical significance for early diagnosis of CHF.