血清胱抑素C对急性冠脉综合征患者预后的预测价值研究

The prognostic predicitive value of Cystatin C in patients with acute coronary syndrome

目的探讨血清胱抑素C(Cys-C)对急性冠脉综合征(ACS)患者近期发生主要不良心血管事件(MACE)(包括心源性猝死),严重的室性心律失常(包括持续性室性心动过速和心室颤动),再次发生非致命性的ACS(再次心绞痛、心肌梗死)及因此再次行血运重建术(包括冠脉支架术、冠脉搭桥术),因充血性心力衰竭再次住院的预测价值。方法纳入195例ACS患者,对195例ACS患者进行随访,随访终点为发生MACE。所有患者均于入院24 h内检测血Cys-C值。按照随访结果将ACS患者分为MACE组和非MACE组。对Cys-C水平与ACS患者的预后的相关性进行分析,并通过多因素预测模型评价各因素对ACS预后的预测价值。结果 MACE组和非MACE组的组间Cys-C值无差异[(1.41±0.46)mg·L^(-1)vs(1.32±0.41)mg·L^(-1),P>0.05];分组后发现MACE组的Cys-C高四分位患者比例略高,非MACE组的Cys-C低四分位患者比例略高,但差异无统计学意义;MACE组的中重度肾功能不全比例明显高于非MACE(34.38%vs 15.34%),而轻中度肾功能不全的比例明显低于非MACE组(18.75%vs 42.33%,P<0.01);在对MACE的单因素回归分析中,Cys-C及其亚组与MACE无相关性。结论该研究发现Cys-C和ACS患者发生MACE无明确相关性。

Objective To discuss the relationship between Cystatin C( Cys-C) and acute coronary syndrome( ACS),to evaluate the correlation between Cys-C and the onset of ACS,andto assess thepredictive value of Cys-C on the number and the recent major adverse cardiac events( MACE) in patients with ACS. Methods One hundred and ninety-fivepatients with ACS were included and followed up. The endpoint of the follow-up was the occurrence of MACE. Serum Cys-C of all patientswas tested within the first 24 hours of admission. The patients with ACS were assigned into MACE group and non-MACE group according to the follow-up results. The correlation of the levels of Cys-C and the prognosis of patients with ACS was analyzed. The predictive value of Cys-C and the prognosis of ACSwere evaluated through the multivariable forecasting model. Results The Cys-C valueshad no difference between MACE group and the nonMACE group [( 1. 41 ± 0. 46) mg·L^(-1) vs( 1. 32 ± 0. 41) mg·L^(-1),P > 0. 05]. The Cys-C group was subdividedinto different quartilesaccording to Cys-C levels and different degreesof renal insufficiency according to e GFR value. The proportion of higher quartile of Cys-C value in MACE group was slightly higher,whilethe proportion of lower quartile of Cys-C value in non-MACE group was slightly higher,but there wereno statisticaldifferences. The proportion of moderate-to-severe renal insufficiency in the MACE group was obviously higher than that in the non-MACE group( 34. 38% vs 15. 34%,P < 0. 01). The proportion of mild-to-moderate renal insufficiency in non-MACE group was obviously higher than that in the MACE group( 42. 33% vs 18. 75%,P < 0. 01). Single variable regression analysis of the MACE showed that there was no correlation of Cys-C group or subgroups with MACE. Conclusions This study found no correlation of Cys-C group or subgroups with MACE.