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目的探讨血清半胱氨酸蛋白酶抑制剂C(CysC)对急性心力衰竭(AHF)的预后价值。方法 2008-04-12-2011-04-25,从广东省人民医院急诊科招募符合入选标准的AHF患者372例作为研究对象。测定血清CysC等指标后进行随访,随访时主要记录死亡和因心血管事件而再次入院等预后指标。研究对象按血清CysC水平由低到高分为4组[Q1(≤1.06mg/L,n=94)、Q2(1.07～1.48mg/L,n=94)、Q3(1.49～1.85mg/L,n=92)、Q4(≥1.86mg/L,n=92)],根据随访结果,评价血清CysC对AHF的预后价值。结果随访的中位数为389d,病死率为25.5%,因心血管事件而再次入院率为34.1%。Kaplan-Meier生存曲线显示,随着血清CysC水平的升高,生存时间明显缩短,因心血管事件而再次入院的风险逐步增加。经Cox回归校正各种混杂因素后,Q2、Q3、Q4相对于Q1,死亡的危险比分别为1.88、2.42、3.71,差异具有统计学意义(P<0.01);因心血管事件而再次入院的危险比分别为1.57、2.50、3.06(P<0.01)。结论血清CysC升高是AHF不良预后的独立危险因子,可作为AHF患者不良临床事件危险分层的指标。
Objective To investigate the prognostic value of serum cystatin C (CysC) in patients with acute heart failure (AHF). Methods A total of 372 AHF patients who met the inclusion criteria were enrolled from the Emergency Department of Guangdong Provincial People ’s Hospital for the study of 2008-04-12-2011-04-25. Serum CysC and other indicators were followed up, the main follow-up record of death and re-admission due to cardiovascular events and other prognostic indicators. Subjects were divided into 4 groups according to the level of serum CysC: Q1 (≤1.06mg / L, n = 94), Q2 (1.07-1.48mg / L, n = 94), Q3 (1.49-1.85mg / L , n = 92), Q4 (≥1.86mg / L, n = 92)]. The prognostic value of serum CysC for AHF was evaluated according to the follow-up results. Results The median follow-up was 389 days with a mortality rate of 25.5% and a re-admission rate of 34.1% due to cardiovascular events. Kaplan-Meier survival curves showed that with the increase of serum CysC, the survival time was significantly shortened, and the risk of re-admission due to cardiovascular events was gradually increased. The hazard ratios of death from Q2, Q3 and Q4 to Q1 were 1.88, 2.42 and 3.71, respectively, after adjusting for various confounding factors by Cox regression. The differences were statistically significant (P <0.01); re-admission due to cardiovascular events The hazard ratios were 1.57, 2.50, 3.06 respectively (P <0.01). Conclusions Elevated serum CysC is an independent risk factor for adverse prognosis of AHF and can be used as an indicator of risk stratification of adverse clinical events in patients with AHF.