血清胱抑素C表达水平在评估心力衰竭预后中的价值

发布时间：2018-07-12 17:29

本文选题：血清胱抑素C + 心力衰竭　；参考：《吉林大学》2013年硕士论文

【摘要】：背景与目的：心力衰竭（Heart failure，HF）仍然是世界范围内导致死亡的主要原因之一。慢性肾脏疾病作为心力衰竭的独立危险因素，，尤其对于那些合并其他心血管危险因素者或者已患有心血管疾病的患者，已得到越来越多的关注。血清胱抑素C (cystatin C，Cys C)是近些年来发现的用于评估肾脏早期功能损伤的血清标志物，对肾小球滤过率(Glomerular filtration rate，GFR)的早期轻微的改变的检测较血清肌酐（serum creatinine，Scr）和尿素氮（urea nitrogen，BUN）更为敏感[1]。近年来国内外临床研究发现高Cys C水平增加老年冠心病的全因死亡率、心血管死亡率及心力衰竭的发生率[2]，而这种风险不能完全被Scr、BUN所预测[3]。Cys C与心血管疾病的发生、发展及预后有关。本研究通过检测心力衰竭患者血清Cys C水平的变化，探讨Cys C表达水平与患者近期（6个月内）预后的关系，并应用血清CysC水平的变化评价短期（6个月）应用血管紧张素转换酶抑制剂治疗对患者肾功能的影响。方法：本研究选取2011年11月—2012年9月期间于吉林大学中日联谊医院心内科住院的心力衰竭患者81例，其中女性39例，男性42例，年龄41～85岁，缺血性心脏病44例，高血压性心脏病12例，扩张型心肌病11例，瓣膜病14例，心功能按纽约心脏病协会（NYHA）分级，NYHA I~II级13例，NYHA III级29例，NYHA IV级39例。同时选取同期就诊于我院的健康体检者81例作为对照组。详细记录患者年龄、性别、体重、身高、收缩压和舒张压，所有入选患者入院后24小时内采取空腹静脉血，测定血清胱抑素C（Cys C）以及空腹血糖、总胆固醇、低密度脂蛋白胆固醇、脑钠肽（BNP）、血肌酐（Scr）、尿素氮(BUN)，并通过超声心动图测定左室射血分数（LVEF）。所有入选患者都接受平均6个月的随访，通过门诊定期复查、电话询问及病例查询等方式，记录患者住院期间以及出院6个月内发生的主要心血管事件（心功能恶化、伴血流动力学障碍的心律失常、再发心肌梗死、伴心电图缺血改变的心绞痛）、任何原因死亡和再入院率[4]，并比较应用ACEI类药物治疗前后的尿素氮、肌酐、血清CysC的水平变化。本研究所有数据均采用统计学软件SPSS17.0进行分析，计数资料以均数±方差表示，计量资料以例数（百分比）表示，多组比较采用单因素方差分析，组间两样本均数比较采用t检验，相关性分析采用直线相关分析；p0.05为差异有统计学意义。研究结果：和对照组相比，心衰组患者的Cys C水平明显升高，且随心功能级别增高，Cys C浓度显著升高，2组血清肌酐及尿素氮水平变化无显著性差异（p0.05）；扩张型心肌病引起的心衰与缺血性心肌病引起的心衰患者相比血清Cys C表达水平有统计学差异（p0.05），其他病因的心衰患者血清Cys C水平无差异（p0.05）；Cys C水平与左室射血分数（LVEF）、收缩压、舒张压及脑钠肽（BNP）的相关性分析,显示发现血清Cys C与LVEF呈负相关（r=-0.551,p0.01），CysC与收缩压呈负相关（r=-0.361，p=0.01），Cys C与舒张压呈负相关（r=-0.391，p=0.008），Cys C与BNP呈正相关（r=0.374，p0.01）；高Cys C组（Cys C≥1.75mg/L）与低Cys C组(Cys C1.75mg/L)比较，显示高Cys C组患者的6个月内全因死亡率、主要心血管事件发生率、6个月内再入院率都明显高于低Cys C组，两者差异有统计学意义(p 0.01)。平均随访6个月，心血管不良事件的患者的Cys C水平明显高于好转患者，两者比较差异有统计学意义（p0.05）。应用ACEI药物治疗6个月后尿素氮、肌酐、血清Cys C水平较治疗前均有所下降，其中尿素氮、肌酐的浓度差异无统计学意义，而血清Cys C的浓度差异有统计学意义。结论： 1、Cys C的水平可反映心衰患者早期肾脏功能的受损，在肾功能正常或轻微受损的心衰患者中，Cys C对全因死亡率及主要心血管事件方面的预测价值优于其他经典的标志物，如肌酐及BNP水平，对心力衰竭有较好的预后价值。 2、在评价心衰程度上血清CysC的水平与BNP、LVEF有较好的相关性。 3、在评价ACEI药物治疗6个月后肾功能变化上血清Cys C较尿素氮、肌酐更敏感。
[Abstract]:Background and purpose: Heart failure (HF) is still one of the major causes of death worldwide. Chronic renal disease is an independent risk factor for heart failure, especially for those with other cardiovascular risk factors or patients who have been suffering from cardiovascular disease. Somatostatin C (cystatin C, Cys C) is a serum marker used to assess early renal impairment in the kidney. The detection of early minor changes in the glomerular filtration rate (Glomerular filtration rate, GFR) is more sensitive than serum creatinine (serum creatinine, Scr) and urinary nitrogen (Cys) in recent years. The study found that high Cys C levels increase the total cause of mortality, cardiovascular mortality and the incidence of heart failure [2], but this risk can not be completely Scr, BUN predicts that [3].Cys C is related to the occurrence, development and prognosis of cardiovascular disease. This study is to explore Cys C by detecting the changes in serum Cys C levels in patients with heart failure. The relationship between the expression level and the prognosis of the patients (6 months) and the changes of serum CysC level were used to evaluate the effect of angiotensin converting enzyme inhibitor therapy on renal function in the short term (6 months).
Methods: This study selected 81 patients with heart failure hospitalized in Department of Cardiology, China Japan Friendship Hospital, Jilin University from November 2011 to September 2012, including 39 women, 42 males, 41~85 years of age, 44 cases of ischemic heart disease, 12 cases of hypertensive heart disease, 11 cases of dilated cardiomyopathy, 14 valvular disease, cardiac function according to New York heart disease association. NYHA grade, NYHA I~II grade 13 cases, NYHA III grade 29 cases, NYHA IV grade 39 cases, and 81 cases of healthy physical examination in our hospital at the same time were selected as control group. The patient's age, sex, weight, height, systolic pressure and diastolic pressure were recorded in detail, and all the selected patients took fasting venous blood within 24 hours after admission to determine serum cystatin C (Cys C). With fasting blood glucose, total cholesterol, low density lipoprotein cholesterol, brain natriuretic peptide (BNP), serum creatinine (Scr), urea nitrogen (BUN) and echocardiography, the left ventricular ejection fraction (LVEF) was measured by echocardiography. All the selected patients were followed up for an average of 6 months. The major cardiovascular events occurring within 6 months of discharge (cardiac deterioration, arrhythmia with hemodynamic disorders, recurrent myocardial infarction, angina pectoris with electrocardiogram), any cause of death and readmission rate [4], were compared with the changes in urea nitrogen, creatinine, and serum CysC levels before and after the treatment of ACEI. All of this study The data were analyzed with statistical software SPSS17.0, the count data were expressed in mean number of variance, and the measured data were represented by the number of cases (percentage). The multiple groups were compared by single factor analysis of variance. The average number of two samples in the group was compared with t test, and the correlation analysis was analyzed by linear correlation analysis, and the difference of P0.05 was statistically significant.
Results: compared with the control group, the level of Cys C in the patients with heart failure was significantly higher, and the level of cardiac function increased, the concentration of Cys C increased significantly. There was no significant difference in serum creatinine and urea nitrogen levels in the 2 groups (P0.05). The serum Cys C expression water was compared with the heart failure caused by dilated cardiomyopathy and ischemic cardiomyopathy. There was no difference in statistical difference (P0.05), and there was no difference in serum Cys C levels in patients with other causes of heart failure (P0.05); the correlation analysis of Cys C level with left ventricular ejection fraction (LVEF), systolic pressure, diastolic pressure and brain natriuretic peptide (BNP) showed that serum Cys C and LVEF were negatively correlated with LVEF (r=-0.551 and BNP). The diastolic pressure was negatively correlated (r=-0.391, p=0.008), Cys C was positively correlated with BNP (r=0.374, P0.01), and the high Cys C group (Cys C > 1.75mg/L) showed the total cause of mortality within 6 months, the incidence of major cardiovascular events and the rate of readmission within 6 months were significantly higher than those of the low Cys group. The study significance (P 0.01). The average follow-up of 6 months of follow-up, the level of Cys C in patients with adverse cardiovascular events was significantly higher than that of the improved patients. The difference was statistically significant (P0.05). After 6 months of ACEI drug treatment, the levels of urea nitrogen, creatinine, and serum Cys C were lower than those before the treatment. There was no statistical difference in the concentration difference between urea nitrogen and creatinine. The difference in serum Cys C concentration was statistically significant.
Conclusion:
1, the level of Cys C can reflect the impairment of early renal function in patients with heart failure. In patients with normal or slight impaired renal failure, the predictive value of Cys C to all causes and major cardiovascular events is superior to other classic markers, such as creatinine and BNP levels, which have good prognostic value for heart failure.
2, there was a good correlation between serum CysC level and BNP and LVEF in evaluating the degree of heart failure.
3, the serum Cys C was more sensitive than urea nitrogen and creatinine after renal function changes after 6 months of ACEI treatment.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R541.6

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