血清胱抑素C水平与慢性心力衰竭患者预后的关系  

Association between serum cystatin C levels and prognosis in heart failure patients

作　　者：朱琛颖[1] 巩昕[1] 于萍[1] 范慧敏[1] 

机构地区：[1]同济大学附属东方医院心衰专科,上海200120

出　　处：《同济大学学报（医学版）》2017年第4期55-59,共5页Journal of Tongji University(Medical Science)

基　　金：国家自然科学基金(81470393);上海市卫计委项目(2014ZYJB0502;ZY3-LCPT-2-1003)

摘　　要：目的探讨血清胱抑素C水平与慢性心力衰竭患者预后的关系。方法连续入选同济大学附属东方医院心力衰竭专科2013年3月至2015年12月期间因慢性心力衰竭失代偿(HFr EF)入院患者共351例,选取同期入住的前临床心力衰竭阶段患者221例作为对照组,所有患者入院后均测定血清胱抑素C水平,对比HFr EF组和对照组血清胱抑素C水平,做胱抑素C与慢性心力衰竭关系的ROC曲线,找出最佳截点分组,比较两组发生事件例数,多因素Logistic回归分析评估胱抑素C对于HFr EF组患者预后的意义。结果 HFr EF组和对照组血清胱抑素C值分别为1.99±1.78和1.31±0.71,两者差异有统计学意义。Pearson相关分析显示:胱抑素C与NT-pro BNP呈正相关(r=0.215,P<0.001),而与hs-CRP及hs-Tn T无相关性。胱抑素C的ROC曲线下面积为0.628,胱抑素C用于慢性心力衰竭预后的评估准确性较低(P<0.001)。以胱抑素C值1.47为截点分为胱抑素C<1.47组和胱抑素C≥1.47组,中位随访时间606 d,统计全因死亡例数分别为32和71,差异有统计学意义(P<0.01)。多因素Logistic回归分析显示:胱抑素C水平评估HFr EF组患者的预后意义不大(P=0.694)。结论在EF下降的慢性心力衰竭患者中胱抑素C水平会普遍升高,但是胱抑素C作为HFr EF评估预后的指标意义不大。Objective To investigate the association between serum cystatin C levels and the prognosis of patients with chronic heart failure. Methods Three hundred and fifty one patients with decompensated chronic heart failure （HFrEF） admitted in heart failure department from March 2013 to December 2015 were enrolled in the study, 221 patients with preclinical heart failure admitted in the same period were selected as the control group. The serum cystatin C levels were measured at admission in two groups. ROC curve was applied to analyze the association between serum cystatin C and chronic heart failure and then best cut-off value of serum cystatin C was chosen. The value of systatin C in prognosis of patients was analyzed by multivariate Logistic regression. Results Serum cystatin C levels in HFrEF and control groups were 1. 99 ± 1. 78 and 1. 31 ±0. 7 1 ,respectively （P 〈0. 001）. Cystatin C was positively correlated with NT-proBNP （ r = 0. 215, P 〈 0. 001）, while not correlated with hypersensitivity CRP and hypersensitivity TnT. The area under ROC curve of cystatin C was 0. 628, takingl.47 as cut-off value of cystatin the sensitivity and specificity for chronic heart failure were 71. 8% and 50. 0 % respectively. Among 351 HFrEF patients, there were 158 cases with cystatin 〈 1. 47 and 193 cases with cystatin C ^ l . 47, after followed up for a median of 606 days, the cases of all-cause death in two groups were 32 and 71, respectively （P 〈0. 001）. Multivariate logistic regression showed that cystatin C was not significantly associated with the prognosis of HFeEF patients （P = 0. 694）. Conclusion Serum cystatin C levels are increased in patients with chronic heart failure, but it may be not used as a prognostic indicator for patients.

关 键 词：心力衰竭 胱抑素C 预后 

分 类 号：R541[医药卫生—心血管疾病]