血清胱抑素C对先天性心脏病相关肺动脉高压患者的预后价值

Prognostic value of serum cystatin C in patients with congenital heart disease-associated pulmonary arterial hypertension

目的探究血清胱抑素C(cystatin C,Cys C)对先天性心脏病相关肺动脉高压(congenital heart disease-associated pulmonary arterial hypertension,PAH-CHD)患者的预后价值。方法回顾性收集新疆医科大学第一附属医院2010年1月—2020年1月首次住院确诊的成人PAH-CHD患者血清Cys C等相关资料。中位随访时间57个月,主要终点事件为全因死亡。根据预后将患者分为生存组和死亡组。使用Cox回归分析PAH-CHD患者全因死亡的危险因素。结果纳入456例患者,其中男160例、女296例,平均年龄(38.99±14.72)岁。基线资料显示,生存组和死亡组静息心率、Cys C、肌酐、N末端脑钠肽前体(NT-proB-type natriuretic peptide,NTproBNP)、超敏肌钙蛋白T(high-sensitivity cardiac troponin T,hs-cTnT)、超敏C反应蛋白(high-sensitivity Creactive protein,hs-CRP)、纽约心脏协会(New York Heart Association,NYHA)心功能分级、血钾指标差异均有统计学意义(P<0.05)。单因素Cox回归分析显示,血清Cys C、NT-proBNP、hs-cTnT、肌酐、NYHA心功能分级是PAH-CHD患者全因死亡的相关危险因素。多因素Cox回归分析进一步显示,血清Cys C[HR=3.820,95%CI(2.053,7.108),P<0.001]、NYHA心功能Ⅲ级[HR=2.234,95%CI(1.316,3.521),P=0.010]、NYHA心功能Ⅳ级[HR=4.037,95%CI(1.899,7.810),P=0.002]和NT-proBNP[HR=1.026,95%CI(1.013,1.039),P<0.001]是PAHCHD患者全因死亡的独立危险因素,具有良好的预测价值。结论血清Cys C作为新的心脏标志物,可预测PAH-CHD患者的全因死亡,为独立危险因素。

Objective To explore the prognostic value of serum cystatin C(Cys C)in patients with congenital heart disease-associated pulmonary arterial hypertension(PAH-CHD).Methods A retrospective cohort study was conducted on adult PAH-CHD patients who were hospitalized for the first time in the First Affiliated Hospital of Xinjiang Medical University from January 2010 to January 2020.The serum Cys C and other related data of patients were collected.The median follow-up time was 57 months.The main end event was all-cause death.According to the prognosis,the patients were divided into a survival group and a death group.Cox regression was used to analyze the risk factors for allcause death in patients with PAH-CHD.Results A total of 456 patients were enrolled,including 160 males and 296females,aged 38.99±14.72 years.The baseline data showed that there were statistical differences in resting heart rate,serum Cys C,creatinine,NT-proB-type natriuretic peptide(NT-proBNP),high-sensitivity cardiac troponin T(hs-cTnT),high-sensitivity C reactive protein(hs-CRP),New York Heart Association(NYHA)cardiac function classification and serum potassium between the survival group and the death group.Univariate Cox regression analysis showed that serum Cys C,NT-proBNP,hs-cTnT,creatinine and NYHA cardiac function classification were related risk factors for all-cause death in patients with PAH-CHD.Multivariate Cox regression analysis showed that serum Cys C(HR=3.820,95%CI2.053-7.108,P<0.001),NYHA gradeⅢ(HR=2.234,95%CI 1.316-3.521,P=0.010),NYHA gradeⅣ(HR=4.037,95%CI1.899-7.810,P=0.002)and NT-proBNP(HR=1.026,95%CI 1.013-1.039,P<0.001)were independent risk factors for allcause death in patients with PAH-CHD and had a good predictive value.Conclusion As a new cardiac marker,serum Cys C can predict all-cause death in patients with PAH-CHD and is an independent risk factor.