老年慢性心力衰竭早期肾损害患者血清轻链蛋白、胱抑素C的浓度及临床意义

Concentrations and clinical significance of serum light chain protein and cystatin C in elderly patients with chronic heart failure and early renal damage

目的探究老年慢性心力衰竭早期肾损害患者血清免疫球蛋白游离轻链(free light chain,FLC)、胱抑素C(cystatin C,Cys-C)的浓度及临床意义。方法选取2016年12月至2019年12月于航天中心医院就诊的老年慢性心力衰竭早期肾损害患者80例作为观察组,另选择同期于航天中心医院进行体检的健康人群80名作为对照组。采用免疫散射比浊法定量测定两组血清轻链蛋白FLCκ、FLCλ浓度;采用免疫透射比浊法检测血清Cys-C浓度;采用Logistic回归分析影响老年慢性心力衰竭早期肾损害发生的危险因素;采用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析血清轻链蛋白FLCκ、FLCλ、Cys-C对老年慢性心力衰竭早期肾损害的诊断价值。结果观察组血清FLCκ、FLCλ及Cys-C[(82.86±28.15)mg/L、(44.46±14.04)mg/L、(1.80±0.49)mg/L]均显著高于对照组[(49.09±15.62)mg/L、(29.09±8.02)mg/L、(0.97±0.26)mg/L],差异有统计学意义(P<0.05)。Logistic回归分析结果显示,血清FLCκ、FLCλ及Cys-C浓度均是影响老年慢性心力衰竭早期肾损害发生的独立危险因素(P<0.05)。ROC分析结果显示,血清FLCκ、FLCλ及Cys-C浓度联合诊断老年慢性心力衰竭早期肾损害的曲线下面积为0.938,明显高于血清FLCκ、FLCλ及Cys-C浓度单独诊断,其诊断敏感度为90.00%,特异度为87.50%。结论血清轻链蛋白FLCκ、FLCλ、Cys-C浓度在老年慢性心力衰竭早期肾损害患者中显著升高,均对该疾病具有一定的诊断价值,且三者联合检测诊断价值更高。

Objectives To investigate the concentrations and clinical significance of serum immunoglobulin free light chain(FLC)and cystatin C(Cys-C)in elderly patients with chronic heart failure and early renal damage.Methods From December 2016 to December 2019 in Aerospace Center Hospital,80 elderly patients with chronic heart failure and early renal damage were selected as observation group,in addition,80 healthy people who had physical examina⁃tion in our hospital at the same period were selected as control group.The concentrations of FLCκ,FLCλand Cys-C in serum of the two groups were measured by immunoturbidimetry.Logistic regression analysis was used to analyze the risk factors of early renal damage in elderly patients with chronic heart failure.Receiver operating characteristic curve(ROC)was used to analyze the value of serum light chain proteins FLCκ,FLCλand Cys-C in the diagnosis of early renal damage in elderly patients with chronic heart failure.Results Serum concentrations of FLCκ,FLCλand Cys-C[(82.86±28.15)mg/L,(44.46±14.04)mg/L,(1.80±0.49)mg/L]in observation group were significantly higher than those in control group[(49.09±15.62)mg/L,(29.09±8.02)mg/L,(0.97±0.26)mg/L](P<0.05).The results of Logistic regression analysis showed that serum concentrations of FLCκ,FLCλand Cys-C were independent risk factors of renal damage in the early stage of patients with chronic heart failure(P<0.05).ROC analysis showed that the area under the curve of serum concentrations of FLCκ,FLCλand Cys-C in the diagnosis of early renal damage in elderly patients with chronic heart failure was 0.938,which was significantly higher than that of serum concentration of FLCκ,FLCλand Cys-C in the diagnosis of single diagnosis,the diagnostic sensitivity and specificity were 90.00%and 87.50%,respectively.Conclusions Serum concentrations of of FLCκ,FLCλand Cys-C in elderly patients with chronic heart failure in the early stage of renal damage significantly increase,which has a certain diagnostic value for the disease,and the combined detection of the three has a higher diagnostic value.