超敏肌钙蛋白T和胱抑素C与慢性心力衰竭患者心功能的相关性研究  

The clinical significance of high sensitive troponin T and Cystatin C in patients with chronic heart failure

作　　者：曹建红[1] 邬美花 于萍[1] 奚晓玲[1] 胡昊[1] 范慧敏[1] 

机构地区：[1]同济大学附属上海市东方医院心衰专科,上海市200120 [2]上海市浦东新区老港社区卫生服务中心,上海市200120

出　　处：《中国心血管病研究》2016年第1期51-54,共4页Chinese Journal of Cardiovascular Research

基　　金：上海市卫计委课题（项目编号：201440046）;同济大学附属上海市东方医院朝阳人才计划（项目编号：DFZY-17）

摘　　要：目的 分析慢性心力衰竭患者超敏肌钙蛋白T（hs-TnT）、胱抑素C（Cys C）水平与心功能和肾功能的相互关系,探讨胱抑素C对慢性心力衰竭早期肾脏损害的诊断价值.方法 检测400例慢性心力衰竭患者的超敏肌钙蛋白T、胱抑素C水平,同时查所有人选患者的肌酐、尿素氮及超声心动图,用简化的肾病饮食改良方程（MDRD）计算估测的肾小球滤过率（eGFR）.结果 根据心功能情况分级,心功能NYHAⅢ、Ⅳ组hs-TnT[（0.024 ±0.610） ng/ml、（0.029±0.690）ng/ml]、Cys C[（1.34±0.31）mg/L、（1.56±0.47）mg/L]、血肌酐[（91 ±37） μmol/L、（121 ±43）μmol/L]及尿素氮[（7.2±3.5）mmol/L、（8.5±4.1）mmol/L]水平均高于NYHAⅡ组[hs-TnT（0.017±0.560）ng/ml、Cys C（1.07±0.29）mg/L、血肌酐（77±31） μmol/L、尿素氮（6.3±2.8）mmol/L];而心功能NYHAⅢ、Ⅳ组[左室射血分数（LVEF）（37±8）％、（32±4）％]、eGFR[（87±31）ml· min-1·（1.72）-1、（68±24） ml· min-1·（1.72）-1]低于NYHAⅡ组[LVEF（49±5）％、eGFR（115±47）ml·min-1·（1.72）-1]（P＜0.05或P＜0.01）.NYHA分级各组之间两两比较hs-TnT、Cys C差异均有统计学意义（P＜0.05）.Hs-TnT、Cys C与LVEF呈负相关（r=-0.41,P＜0.01;r=-0.46,P＜0.01）;hs-TnT与Cys C呈显著正相关（r=0.76,P＜0.01）.结论 慢性心力衰竭更易合并肾功能异常,主要表现为肾小球滤过功能受损;心衰程度越重,肾功能损害越明显.Hs-TnT、Cys C可作为评价慢性心力衰竭患者病情加重的指标,Cys C可用于慢性心衰患者早期肾功能损害的诊断指标.Objective To evaluate and analyze relationship of high sensitive troponin T （hs-TnT） and Cystatin C （Cys C ） with cardiac and renal function in patients with chronic heart failure, and explore significance of Cys C measurement in early diagnosis for renal damage in patients with CHF. Methods 400 patients with CHF were enrolled as study group, and undergone routine physical check-up. Their plasma level of hs-TnT and serum level of Cys C, as well as serum level of creatinine（Scr）, blood urea nitrogen（BUN ） were measured and echocar- diography was performed. Glomerular filtration rate （eGFR） was evaluated by modification of diet in renal disease （MDRD）study group formula. Results Compared with the NYHA function classes 11 group, blood level of hs- TnT（0.024±0.610 ）ng/ml, （0.029±0.690）ng/ml, Cys C （ 1.34±0.31 ）mg/L, （ 1.56±0.47 ）mg/L, Scr （91±37 ） μmol/L, （121±43）μmol/L and BUN （7.2±3.5）mmol/L, （8.5±4.1）mmol/L elevated, both LVEF （37±8）%, （32±4）% and eGFR（87±31 ）ml·min-1·（1.72）-1, （68±24）ml·min-1·（1.72）-1 decreased（P〈0.05 or P〈0.01 ） in the NYHA func-tion classes Ⅲ group and the NYHA function classes Ⅳ group. Blood leves of hs-TnT and Cys C elevated signifi- cantly and LVEF lowered significantly in CHF patients with NYHA function Ⅲ and IV groups than those NYHA function classes Ⅱ group. There was significantly difference in blood leves of hs-TnT and Cys C reversely corre- lated with LVEF（r=-0.41, P〈0.01, r=-0.46, P〈0.01 ）. Blood level of hs-TnT correlated with of Cys C（r=0.76, P〈0.01 ）. Conclusion Patients with CHF were more likely to complicate with renal dysfunction than controls, with main manifestation of more severe damaged eGFR, more severe heart failure and more obviously renal dam- age. Blood levels of hs-TnT and Cys C can be used as indicators for evaluating exacerbation of chronic condition, and serum level of Cys C can be used as maker for early diagnosing renal damage in patients

关 键 词：超敏肌钙蛋白T 胱抑素C 慢性心力衰竭 

分 类 号：R541.6[医药卫生—心血管疾病]