血清胱抑素C水平对甲亢性心力衰竭患者预后的影响

Impact of serum cystatin C level on prognosis in patients with hyperthyroid heart failure

目的 探讨血清胱抑素C(Cys-C)在甲亢性心力衰竭患者预后评估中的价值。方法 选取89例甲亢性心力衰竭患者,根据血清Cys-C 水平分为Cys-C 正常组46例(血清Cys-C<1.8 mg/L)和Cys-C 升高组43例(血清Cys-C ≥ 1.8 mg/L)。比较两组入院时临床基线资料,所有入选患者均于出院后随访180 d,以心源性死亡、恶性心律失常、心功能恶化再住院为研究终点,比较两组180 d 累积无事件生存率,并应用COX 比例风险模型分析甲亢性心力衰竭患者发生终点事件的危险因素。结果 Cys-C升高组N 末端B 型钠尿肽前体(NT-proBNP)、左室舒张末内径(LVDd)高于Cys-C 正常组,左室射血分数(LVEF)低于Cys-C 正常组,NYHA 心功能分级劣于Cys-C 正常组,差异有统计学意义(均P<0.05),Cys-C 升高组180 d 累积无事件生存率为62.1%,Cys-C 正常组为84.5%,经Log-rank 检验显示两组患者无事件生存率差异有统计学意义(P<0.05)。经COX 回归分析显示,血清Cys-C(RR =2.786,95%CI :1.076-7.119)是甲亢性心力衰竭预后不良的独立危险因素。结论 血清Cys-C 水平与甲亢性心力衰竭的严重程度及预后密切相关,可作为甲亢性心力衰竭患者预后评估的重要指标。

Objective To explore the value of serum Cystatin C (Cys-C) level in predicting the prognosis of patients with hyperthyroid heart failure. Methods 89 patients with hyperthyroid heart failure were divided into a normal Cys-C group (46 cases) with a serum Cystatin C level < 1.8 mg/L and a high Cys-C group (43 cases) with a serum Cystatin C level ≥1.8 mg/L. The clinical baseline data were compared between the two groups at admission. All the patients were followed up 180 days after discharge;and the cardiac death, malignant arrhythmias, and rehospitalization for cardiac function aggravation were defined as the outcome of the study. The event-free survival rates of the two groups were compared. COX proportional risk model was used to analyze the risk factors of the endpoint events in the patients. Results Compared with the normal Cys-C group, the high Cys-C group had higher levels of NT-proBNP and LVDd and lower levels of LVEF and NYHA functional grading, with statistical differences (all P < 0.05). The 180 d event-free survival rate in the high Cys-C group was 62.1%, and that in the normal Cys-C group 84.5%. There was a statistical difference in the event-free survival rate between two groups by Log-rank test (P < 0.05). COX regression analysis showed that serum Cystatin C (RR=2.786, 95%CI:1.076-7.119) was an independent risk factor for the poor prognosis in the patients. Conclusion Serum Cystatin C has inseparable relationship with the disease severity and prognosis of hyperthyroid heart failure, and it can be used as an indicator to evaluate the prognosis of patients with hyperthyroidism heart failure.