血清集聚蛋白C末端片段水平在老年心力衰竭并发肾损伤患者中的临床意义

Elevated levels of C-terminal agrin fragment and its significance in elderly patients with heart failure complicated with renal injury

目的检测老年心力衰竭(简称心衰)患者血清集聚蛋白C末端片段(C-terminalagrin-fragment,CAF)水平,分析其与心衰并发肾损伤的相关性。方法收集2013年12月至2014年12月在皖南医学院弋矶山医院住院的NYHA分级3~4级的老年心衰患者180例;根据是否eGFR<60mL/(min·1.73m^2),将入选的心衰患者分为肾损伤组和非肾损伤组。比较两组间临床特征、实验室检查指标及血清CAF水平。结果心衰患者中有71例患者并发肾损伤,肾损伤组血清CAF水平显著高于非肾损伤组(ng/L:975±369vs.712±350,P=0.028)。相关性分析显示,心衰并发肾损伤与CAF水平密切相关(r=0.249,P=0.001),在校正年龄、性别、血肌酐、胱抑素C等因素后,CAF升高仍是肾损伤的危险因素之一(OR=1.102,95%CI1.008~1.118,P<0.045)。受试者工作特征曲线(ROC)分析显示,CAF>760.7ng/L判断肾损伤的AUC为0.690,预测敏感度0.842,特异度为0.423。结论部分心衰患者并发肾损伤,其血清CAF水平升高,并与肾功能密切相关,异常升高的血清CAF对判断心衰并发肾损伤有重要的临床意义。

Objective To assess the levels of C - terminal agrin - fragment ( CAF) and analyze its correlation with renal injury in elderly patients with heart failure. Methods A total of 180 elderly heart failure patients with NYHA class 3-4 who hospitalized into our hospital from December 2013 to December 2014 were enrolled. Based on estimate glomerular filtration rate ( eGFR < 60 mL ·( min · 1.73 m2), patients with heart failure were divided into renal injury and non - kidney injury groups. Clinical characteristics, laboratory tests, and serum CAF levels were compared between the two groups. Results Among these heart failure patients, 71 cases were complicated with renal injury. Serum CAF level in the renal injury group was significantly higher than that in the non - kidney injury group( ng/L: 975 ± 369 vs. 712 ± 350,P = 0. 028 ). Correlation analysis showed that heart failure complicated with renal injury was significantly associated with serum CAF level ( r = 0. 249, P = 0. 001 ). Even after adjusting for age, gender, serum creatinine, cystatin C and other factors, the increase of serum CAF is still the risk of kidney injury ( OR = 1. 102, 95% CI 1.008 - 1. 118 , P V 0. 045). ROC analysis showed that the AUC of CAF > 760. 7 ng/L for identified kidney injury was 0. 690, with the predictive sensitivity of 0. 842 , and the specificity of 0. 423. Conclusion Some patients with heart failure are complicated with renal injury, and the elevated serum CAF levels are correlated with renal function. Abnormally elevated serum CAF has an important clinical significance in identifying renal injury in heart failure patients.