老年急性冠脉综合征病人血清胱抑素C与冠脉病变程度的关系

doi:10.3969/j.issn.1003-9198.2021.05.018

摘要/Abstract

摘要： 目的探讨血清胱抑素C(Cys C)与老年急性冠脉综合征(ACS)病人冠脉病变程度的关系。方法选取经冠状动脉造影检查确诊ACS的病人246例作为观察组,38例同期经冠脉造影检查排除冠心病的病人作为对照组。检测所有病人24 h内Cys C水平,将ACS病人血清Cys C水平与Gensini评分作相关性分析。结果随着病变程度增加,血清Cys C水平逐渐升高,组间比较差异均有统计学意义(P＜0.01)。血清Cys C水平与ACS病人Gensini评分呈正相关(r=0.436,P＜0.05)。Logistic回归模型和多元线性回归模型显示,Cys C是影响ACS和Gensini评分的危险因素(OR=1.843,B=5.076,均P＜0.05)。ROC曲线示Cys C预测ACS的界值为8.35 mg/dL,灵敏度为0.683,特异度为0.763。结论 ACS病人血清Cys C水平与冠脉病变严重程度相关,是影响冠脉病变程度的危险因素。

关键词: 急性冠脉综合征, 胱抑素C, Gensini评分

Abstract: Objective To investigate the relationship between serum cystatin C (Cys C) and the degree of coronary artery disease in the elderly patients with acute coronary syndrome (ACS). Methods A total of 246 patients with ACS confirmed by coronary angiography were selected as the observation group, and 38 patients without coronary heart disease excluded by coronary angiography during the same period were selected as the control group. The level of serum Cys C in all the patients was detected within 24 hours, and the correlation between the level of serum Cys C and Gensini score in the patients with ACS was analyzed. Results With the increase of the degree of coronary lesion, the level of serum Cys C increased gradually, and there were statistical differences among different groups (P < 0.01). The level of serum Cys C was positively correlated with Gensini score in the patients with ACS (r=0.436, P<0.05). Logistic regression model and multiple linear regression model showed that the level of serum Cys C was an risk factor for ACS and Gensini score (OR=1.843, B=5.076,all P < 0.05). Receiver operating characteristic curve showed that Cys C could predict the incidence of ACS with a critical value of 8.35 mg/dL, with sensitivity of 0.683, specificity of 0.763. Conclusions The level of serum Cys C in the patients with ACS is related to the severity of coronary artery disease, which is a risk factor for the aggravation of coronary artery disease.

Key words: acute coronary syndrome, cystatin C, Gensini score

中图分类号:

R 543.3

刘雅娟, 尹磊, 李鹏, 王其新. 老年急性冠脉综合征病人血清胱抑素C与冠脉病变程度的关系[J]. 实用老年医学, 2021, 35(5): 503-506.

LIU Ya-juan, YIN Lei, LI Peng, WANG Qi-xin. Relationship between the level of serum cystatin C and severity of coronary lesions in the elderly patients with acute coronary syndrome[J]. Practical Geriatrics, 2021, 35(5): 503-506.

参考文献

[1] ZHANG J, WU X, GAO P, et al. Correlations of serum cystatin C and glomerular filtration rate with vascular lesions and severity in acute coronary syndrome[J]. BMC Cardiovasc Disord, 2017, 17(1): 47.
[2] VIRANI S S, ALONSO A, BENJAMIN E J, et al. Heart disease and stroke statistics-2020 update: A Report From the American Heart Association[J]. Circulation, 2020, 141(9): e139-e596.
[3] TAN Z, LI L, MA Y, et al. Clinical significance of Cys-C and hs-CRP in coronary heart disease patients undergoing percutaneous coronary intervention[J]. Braz J Cardiovasc Surg, 2019, 34(1): 17-21.
[4] SHLIPAK M G, SARNAK M J, KATZ R, et al. Cystatin C and the risk of death and cardiovascular events among elderly persons[J]. N Engl J Med, 2005, 352(20): 2049-2060.
[5] ABID L, CHARFEDDINE S, KAMMOUN S, et al. Cystatin C: a prognostic marker after myocardial infarction in patients without chronic kidney disease[J]. J Saudi Heart Assoc, 2016, 28(3): 144-151.
[6] MAAHS D M, OGDEN L G, KRETOWSKI A, et al. Serum cystatin C predicts progression of subclinical coronary atherosclerosis in individuals with type 1 diabetes[J]. Diabetes, 2007, 56(11): 2774-2779.
[7] AMSTERDAM E A, WENGER N K, BRINDIS R G, et al. 2014 AHA/ACC Guideline for the Management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines[J]. J Am Coll Cardiol, 2014, 64(24): e139-e228.
[8] RAMPIDIS G P, BENETOS G, BENZ D C, et al. A guide for Gensini Score calculation[J]. Atherosclerosis, 2019, 287: 181-183.
[9] 中国医师协会急诊医师分会, 国家卫健委能力建设与继续教育中心急诊学专家委员会, 中国医疗保健国际交流促进会急诊急救分会. 急性冠脉综合征急诊快速诊治指南(2019)[J]. 中华急诊医学杂志, 2019, 4(28): 421-428.
[10]VAN HOLTEN T C, WAANDERS L F, DE GROOT P G, et al. Circulating biomarkers for predicting cardiovascular disease risk; a systematic review and comprehensive overview of meta-analyses[J]. PLoS One, 2013, 8(4): e62080.
[11]TAGLIERI N, KOENIG W, KASKI J C. Cystatin C and cardiovascular risk[J]. Clin Chem, 2009, 55(11): 1932-1943.
[12]HAMZIC-MEHMEDBASIC A. Inflammatory cytokines as risk factors for mortality after acute cardiac events[J]. Med Arch, 2016, 70(4): 252-255.
[13]HOKE M, AMIGHI J, MLEKUSCH W, et al. Cystatin C and the risk for cardiovascular events in patients with asymptomatic carotid atherosclerosis[J]. Stroke, 2010, 41(4): 674-679.
[14]HUANG Q, SHEN W, LI J, et al. Association of serum cystatin C levels with acute coronary syndrome in patients of advanced age[J]. J Int Med Res, 2019, 47(5): 1987-1997.
[15]NEGRUSZ-KAWECKA M, POREBA R, HULOK A, et al. Evaluation of the significance of cystatin C levels in patients suffering from coronary artery disease[J]. Adv Clin Exp Med, 2014, 23(4): 551-558.
[16]ALHUSSEINY A H, AL-NIMER M S, AL-NEAMY S I. Assessment of serum cystatin C levels in newly diagnosed acute myocardial infarction at the onset and at the time of hospital discharge[J]. Cardiol Res, 2015, 6(1): 226-231.