血清胱抑素C水平与慢性心力衰竭患者心室重塑、心功能及心房颤动的相关性分析

Correlation of serum cystatin C with ventricular remodeling,cardiac function and atrial fibrillation in patients with chronic heart failure

目的分析血清胱抑素C(Cys-C)水平与慢性心力衰竭(下称心衰)患者左心室重塑、心功能及心房颤动(下称房颤)的相关性。方法选择2018年10月至2020年11月浙江省医疗健康集团杭州医院收治的慢性心衰患者110例为观察组,依据纽约心脏病协会(NYHA)心功能分级分为Ⅰ级亚组22例、Ⅱ级亚组31例、Ⅲ级亚组40例;Ⅳ级亚组17例;再分为房颤者34例,非房颤者76例。另择同期本院健康体检者90名为对照组。测定血清Cys-C水平。行超声心动图检查,检测左心室射血分数(LVEF)、左心室舒张末期室间隔厚度(IVST)、左心室后壁厚度(PWT)、左心室舒张末期内径(LVEDd)及左心房内径(LAD),计算左心室质量(LVM)。采用Spearman秩相关分析血清Cys-C水平与房颤、LVEF、LVEDd、LVM的相关性。结果对照组Cys-C水平最低,I级亚组到Ⅳ级亚组Cys-C水平逐渐增高,各组间比较差异均有统计学意义(均P<0.05)。房颤患者血清Cys-C水平高于非房颤患者,差异有统计学意义(P<0.05)。观察组LVEF低于对照组,LVEDd、LVM高于对照组,差异均有统计学意义(均P<0.05);Ⅳ级亚组LVEF低于Ⅰ、Ⅱ、Ⅲ级亚组,LVEDd、LVM高于Ⅰ、Ⅱ、Ⅲ级亚组,差异均有统计学意义(均P<0.05)。Spearman秩相关分析显示,血清Cys-C水平与LVEF呈负相关(rs=-0.786,P<0.05),与房颤、LVEDd、LVM均呈正相关(rs=0.242、0.703、0.530,均P<0.05)。结论血清Cys-C在慢性心衰患者中呈高表达,表达水平与心功能及房颤密切相关。

Objective To analyze the correlation between serum cystatin C(Cys-C) levels and left ventricular(LV)remodeling,cardiac function,and atrial fibrillation (AF) in patients with chronic heart failure (CHF).Methods A total of 110 patients with CHF admitted to Zhejiang Medical Health Group Hangzhou Hospital from October 2018 to November 2020 were selected as observation group.They were classified as NYHA grade Ⅰ subgroup(n=22),grade Ⅱ subgroup(n=31),grade Ⅲ subgroup(n=40),and grade Ⅳ subgroup(n=17).AF was diagnosed in 34 cases and not in76 cases.90 healthy people were selected as the control group.Serum Cys-C levels was measured.Echocardiography was performed and LV ejection fraction(LVEF),LV end diastolic interventricular septal thickness(ⅣST),LV posterior wall thickness(PWT),LV end diastolic diameter(LVEDd) and left atrial diameter(LAD) were measured.LV mass(LVM)was calculated.Spearman rank correlation was used to analyze the correlation between Cys-C and AF,LVEF,LVEDd,and LVM.Results Cys-C level was lowest in the control group,and gradually increased from NYHA grade Ⅰ to NYHA grade Ⅳ group,with significantly different between groups(all P<0.05).Cys-C was significantly higher in patients with AF than in patients without AF(P<0.05).LVEF was significantly lower,LVEDd and LVM were significantly higher in observation group compared with control group(all P<0.05).LVEF was significantly lower,LVEDd and LVM were significantly higher in grade Ⅳ group than in other three groups(all P<0.05).Spearman rank correlation analysis revealed that serum Cys-C levels were negatively correlated with LVEF(rs=-0.786,P<0.05) and positively correlated with AF,LVEDd,and LVM(rs=0.242,0.703,0.530,P<0.05).Conclusion Serum Cys-C is highly expressed in patients with CHF and closely related to cardiac function and AF.