摘要
目的探讨血浆胱抑素c（cystatinC，CysC）水平对急性冠脉综合征（acutecoronarysyndromes，ACS）患者经皮冠状动脉介入（percutanceouscoronaryintervention，PCI）术后预后的判断价值。方法连续选取2009年9月至2010年6月于郑州大学第一附属医院心内科住院的ACS患者660例为研究对象。入选标准：冠脉造影显示至少一支血管狭窄程度为75％以上，成功接受PCI手术治疗，且肾功能正常或存在轻度肾功能不全[肾小球滤过率（GFR）〉60m1／（min·1．73m^2）]。排除标准：严重肝肾功能损伤或患有肿瘤、心脏瓣膜病。记录患者人院24h内血浆CysC浓度（乳胶增强免疫比浊法）及其他临床资料。于2011年3月至7月进行门诊和电话随访，记录心脏不良事件的发生情况。根据CysC四分位数将患者分为4组：Q1（CysC〈1．02mg／L）、Q2（1．02mg／L≤CysC〈1．17mg／L）、Q3（1．17mg／L≤CysC〈1．35mg／L）和Q4（CysC≥1．35mg／L）。应用单因素分析和多因素Cox比例风险回归模型探索与预后相关的因素，组问率的比较采用X^2检验，Kaplan-Meier生存曲线比较不同CysC水平患者生存率的区别。以P〈0．05为差异具有统计学意义。结果（1）成功随访605例（随访率91．7％），随访时间为（14．3±1．7）个月。95例患者发生心脏不良事件（发生率15．7％）。（2）组问比较发现Q2、Q3、Q4组心脏不良事件的发生率高于Q1（P〈0．01），Q4组较Q1组死亡、心梗或血运重建事件的发生明显增加（P〈0．05），Q3、Q4组较Q1组心力衰竭的发生率升高（P〈0．05）。（3）单因素分析显示：CysC、肌酐、年龄、左室射血分数（1eftventrieularejectionfraction，LVEF）、既往PCI史、纽约心脏病学会（NYHA）心功能分级≥3级，是患者出现心脏不良事件的危险因素（P〈0．05）。（4）多因素Cox同归结果显示：与Q1相比，Q3和Q4发生心脏不良事件的相对危险度（relativerisk，RR）分别为3．930（95％C／1．306-11．829，P=0．015）和6．38（95％C／2．171-18．751，P=0．001）。（5）Kaplan-Meier生存曲线分析显示：Q2、Q3、Q4组的无心脏事件的累积生存率低于Q1组（P=0．001）。结论CysC水平是判断ACS患者PCI术后发生心脏不良事件的独立预测因子。
Objective To investigate the predictive value of plasma cystatin C （CysC） in patients with acute coronary syndrome （ACS） after percutaneous coronary intervention （PCI） . Methods A total of 660 patients with ACS admitted to cardiovascular department were enrolled in this study from January 2009 to June 2010. The enrollment criteria were： （ 1 ） the stenosis degree was above 75% in at least one coronaryartery checked by coronary angiography and successful PCI; （2） normal renal function or mild dysfunction with glomerular filtration rate （GFR） 〉60 ml/ （min· 1.73 m^2）. Exclusion criteria were severe liver and renal insufficiency, malignancies and valvular heart diseases. The plasma CysC levels were examined by the latex enhanced immune turbidity method within 24 hours after admission. The relevant clinical data were recorded. The patients were followed up by out-patient interview or telephone from March to June 2011 and adverse cardiovascular events were recorded. The patients were divided into four groups according to CysC level： Q1 （CysC〈1.02mg/L）, Q2 （1.02mg/L≤CysC 〈1.17 mg/ L）, Q3 （1.17 mg/L ≤ CysC 〈 1.35 rag/L） and Q4 （CysC ≥ 1.35 mg/L）. Univariate and multivariate Cox hazards regressions were established to analyze the factors related to prognosis. The proportion differences between four groups were tested by X^2. The survival ratio was estimated using the Kaplan-Meier method. Statistical significance was established at a P value of less than 0. 05. Results ① A total of 606 （91.7%） patients successfully accepted follow-up. Mean follow-up time was （ 14. 3 ±1.7） months. Of them, 95 patients were subjected to adverse cardiovascular events （ 15.7% ）. ②The incidences of adverse cardiovascular events in Q2, Q3, Q4 were significantly higher than those in Q1 （ P 〈 0. 001 ）. The rates of mortality, nonfatal myocardial infarction and target lesion revascularization in Q4 were higher than those in Q1 （ P 〈 0. 05 ）. The incidences of heart failure in Q3 and Q4 were higher than that in Q1 （ P 〈 0. 05 ）. ③Univariate analysis demonstrated that CysC, creatinine, LVEF, age, history of PCI and NYHA grade i〉 3 were the risk factors of poor prognosis （ P 〈 0. 05 ）. ④Multivarite cox hazards regression revealed that the elevation of CysC level remained an independent predictor of adverse cardiovascular events. The relative risk of Q3 and Q4 were 3. 930 （95% CI 1. 306 - 11. 829, P =0. 015 ） and 6. 380 （95% CI 2. 171 - 18. 751, P =0. 001 ） compared with Q1. @The cumulative rates of survival without adverse cardiovascular events in Q2, Q3 and Q4 decreased compared with Q1 （ P 〈 0. 001 ）. Conclusions High plasma CysC concentration is an independent predictor of adverse cardiovascular events in patients with ACS after PCI.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2012年第7期694-700,共7页
Chinese Journal of Emergency Medicine
基金
河南省高校科技创新人才专项基金（2012HASTIT001）
河南省卫生科技创新人才工程专项基金
2012年度河南省医学科技攻关计划（201203027）
