基线血清胱抑素C水平与肾功能正常的PCI术后患者预后的关系

Relation between baseline serum cystatin C level and prognosis of patients with normal renal function after PCI

目的:评估术前血清胱抑素C(Cys-C)水平与肾小球滤过率正常的PCI术后患者预后的关系。方法:回顾性分析580例行PCI术的冠心病患者的临床及实验室资料,术前肾小球滤过率均正常。术后随访6~78个月。绘制术前血清Cys-C水平预测术后3 a全因死亡的ROC曲线,确定最佳截断值,依据该值将患者分为术前血清Cys-C高水平组和低水平组。比较两组术后3 a全因死亡、心源性死亡、主要心脏不良事件(MACE)及主要不良心脑血管事件(MACCE)发生率,Kaplan-Meier法绘制两组的生存曲线。采用Cox回归筛选预后影响因素。结果:术前血清Cys-C最佳截断值为1.32μmol/L,血清Cys-C高水平(≥1.32μmol/L)53例,低水平(<1.32μmol/L)527例。高水平组术后3 a全因死亡率、心源性死亡率均高于低水平组(P均<0.05)。Cox回归分析结果显示,术前血清Cys-C增高是肾功能正常的PCI术后患者全因死亡的影响因素,HR(95%CI)为5.036(2.340~10.796)。结论:术前血清Cys-C水平升高可预测肾功能正常的PCI术后患者的死亡风险增加。

Aim:To evaluate the relation between baseline serum cystatin C(Cys-C) and prognosis of patients with normal renal function after PCI.Methods:The clinical and laboratory data of 580 coronary artery disease patients undergoing PCI were retrospectively analyzed.All the patients had normal glomerular filtration rate before PCI and were followed up for 6-78 months after PCI.The ROC curve of preoperative serum Cys-C level predicting all-cause death within 3 years after PCI were drawn,the cut-off value was determined,and the cases were allocated into high serum Cys-C group and low serum Cys-C group.The rate of all-cause death,cardiogenic death,major adverse cardiac events(MACE) and major adverse cardiac and cerebrovascular events(MACCE) 3-year after PCI were compared between the two groups.The survival curves were plotted by Kaplan-Meier method.Cox regression was used to screen prognostic factors.Results:The optimal value of serum Cys-C before PCI was 1.32 μmol/L,53 patients were in high serum Cys-C(≥1.32 μmol/L) group and 527 were in low serum Cys-C(<1.32 μmol/L) group.All-cause mortality and cardiogenic mortality within 3 years of high serum Cys-C group were higher than those of low serum Cys-C group(P<0.05).Cox regression analysis showed that the increase of serum Cys-C before PCI was the cause of all-cause death in patients with normal renal function after PCI,HR(95%CI) was 5.036(2.340-10.796).Conclusion:Elevated serum Cys-C level predicts an increased risk of death after PCI in patients with normal renal function.