血清胱抑素C对肾功能正常的NSTE-ACS患者危险分层的评估价值

Estimated value of serum cystatin C for the risk stratification of non ST-elevation acute coronary syndrome patients with normal renal function

目的探讨血清胱抑素C(CysC)水平对肾功能正常的非ST段抬高型急性冠脉综合征(NSTE-ACS)患者危险分层的评估价值。方法选取2015年1月~2016年12月在徐州医科大学附属医院经冠状动脉造影确诊为NSTE-ACS的患者280例为实验组,经冠状动脉造影排除NSTE-ACS的患者40例为对照组。根据全球急性冠脉事件注册(GRACE)评分将实验组分为低危组(≤108分,47例)、中危组(109~140分,106例)、高危组(>140分,127例);探究CysC水平在不同组间的差异及与GRACE评分的相关性,探讨GRACE评分的独立影响因素,受试者工作曲线(ROC)分析CysC对高危NSTE-ACS的预测价值。Logistic多因素回归分析高危NSTE-ACS的独立预测指标。结果实验组CysC水平明显高于对照组(P<0.05);CysC水平与GRACE评分呈正相关(r=0.561,P<0.05);CysC是GRACE评分及高危风险的独立预测因素(P<0.05),ROC分析示:AUC为0.788,P<0.05,最佳界点值为0.94,灵敏度为77%,特异度为72%。结论肾功能正常的NSTE-ACS患者血清CysC水平与其危险分层密切相关,是其危险分层及高危风险的独立预测因子。

Objective To explore the estimated value of serum cystatin C（CysC） for the risk stratification of non STelevation acute coronary syndrome（NSTE-ACS） patients with normal renal function. Methods Two hundred and eighty patients diagnosed as NSTE-ACS by coronary angiography in Affiliated Hospital of Xuzhou Medical University from January 2015 to December 2016 were selected as experimental group, 40 healthy subjects without NSTE-ACS diagnosed by coronary angiography were selected as control group. According to the scores of global registry of acute coronary events（GRACE）, the experimental group was further divided into low risk group（≤108 points, 47 cases）, moderate risk group（109-140 points, 106 cases） and high risk group（140 points, 127 cases）. The differences of CysC between different groups and the correlation with GRACE score were explored, the independent predictive factors of GRACE scores were investigated, the estimated value of CysC for high risk of NSTE-ACS was analyzed by receiver operating characteristics（ROC）, the independent predictive factors of high risk of NSTE-ACS were analyzed by Logistic multivariate regression analysis. Results The levels of CysC in experimental group were significantly higher than those of control group（P 0.05）. The levels of CysC were positively correlated with GRACE scores（r = 0.561, P 0.05）.The CysC is an independent predictive factor of GRACE score and high risk of NSTE-ACS（P 0.05）. The ROC curve analysis showed that AUC was 0.788, P 0.05, the best cut-off point was 0.94, the sensitivity was 77%, the specificity was 72%. Conclusion The levels of CysC in NSTE-ACS patients with normal renal function are closely related to its risk stratification, which is the independent predictive factor of risk stratification and high risk of NSTE-ACS.