胱抑素C对急性冠脉综合征PCI术预后的判断
광억소C대급성관맥종합정PCI술예후적판단
The predictive value of cystatin C in patients with acute coronary syndrome after percutaneous coronary intervention
  • 万方数据
    中华急诊医学杂志 중화급진의학잡지
    CHINESE JOURNAL OF EMERGENCY MEDICINE
    2012年 7期 694-700 ,共7页

    孙同文%徐青艳%姚海木%张晓娟%吴琼%姚瑞%张金盈%李凌%关方霞%阚全程

    손동문%서청염%요해목%장효연%오경%요서%장금영%리릉%관방하%감전정

    急性冠脉综合征%血管成形术%经皮冠状动脉介入%胱抑素C%心脏不良事件 急性冠脈綜閤徵%血管成形術%經皮冠狀動脈介入%胱抑素C%心髒不良事件
    급성관맥종합정%혈관성형술%경피관상동맥개입%광억소C%심장불량사건
    Acute coronary syndrome%Angioplasty%Percutaneous coronary intervention%Cystatin C%Adverse cardiovascular events
    目的 探讨血浆胱抑素C (cystatin C,CysC)水平对急性冠脉综合征(acute coronary syndromes,ACS)患者经皮冠状动脉介入(percutanceous coronary intervention,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)＞60mL/ (min·1.73 m2)].排除标准:严重肝肾功能损伤或患有肿瘤、心脏瓣膜病.记录患者入院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( 1.02 mg/L≤CysC＜ 1.17 mg/L)、Q3( 1.17 mg/L≤CysC＜1.35 mg/L)和Q4(CysC≥1.35 mg/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,组间率的比较采用x2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)组间比较发现Q2、Q3、Q4组心脏不良事件的发生率高于QI (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(left ventricular ejection fraction,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回归结果显示:与Q1相比,Q3和Q4发生心脏不良事件的相对危险度(relative risk,RR)分别为3.930(95％ CI1.306～ 11.829,P=0.015)和6.38 (95％ CI2.171 ～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.
    목적 탐토혈장광억소C (cystatin C,CysC)수평대급성관맥종합정(acute coronary syndromes,ACS)환자경피관상동맥개입(percutanceous coronary intervention,PCI)술후예후적판단개치.방법 련속선취2009년9월지2010년6월우정주대학제일부속의원심내과주원적ACS환자660례위연구대상.입선표준:관맥조영현시지소일지혈관협착정도위75％이상,성공접수PCI수술치료,차신공능정상혹존재경도신공능불전[신소구려과솔( GFR)＞60mL/ (min·1.73 m2)].배제표준:엄중간신공능손상혹환유종류、심장판막병.기록환자입원24h내혈장CysC농도(유효증강면역비탁법)급기타림상자료.우2011년3월지7월진행문진화전화수방,기록심장불량사건적발생정황.근거CysC사분위수장환자분위4조:Q1 (CysC＜ 1.02mg/L)、Q2( 1.02 mg/L≤CysC＜ 1.17 mg/L)、Q3( 1.17 mg/L≤CysC＜1.35 mg/L)화Q4(CysC≥1.35 mg/L).응용단인소분석화다인소Cox비례풍험회귀모형탐색여예후상관적인소,조간솔적비교채용x2검험,Kaplan-Meier생존곡선비교불동CysC수평환자생존솔적구별.이P＜0.05위차이구유통계학의의.결과 (1)성공수방605례(수방솔91.7％),수방시간위(14.3±1.7)개월.95례환자발생심장불량사건(발생솔15.7％).(2)조간비교발현Q2、Q3、Q4조심장불량사건적발생솔고우QI (P＜0.01),Q4조교Q1조사망、심경혹혈운중건사건적발생명현증가(P＜0.05),Q3、Q4조교Q1조심력쇠갈적발생솔승고(P＜0.05).(3)단인소분석현시:CysC、기항、년령、좌실사혈 분수(left ventricular ejection fraction,LVEF)、기왕PCI사、뉴약심장병학회( NYHA)심공능분급≥3급,시환자출현심장불량사건적위험인소(P＜0.05).(4)다인소Cox회귀결과현시:여Q1상비,Q3화Q4발생심장불량사건적상대위험도(relative risk,RR)분별위3.930(95％ CI1.306～ 11.829,P=0.015)화6.38 (95％ CI2.171 ～18.751,P=0.001).(5) Kaplan-Meier생존곡선분석현시:Q2、Q3、Q4조적무심장사건적루적생존솔저우Q1조(P=0.001).결론CysC수평시판단ACS환자PCI술후발생심장불량사건적독립예측인자.
    Objective To investigate the predictive value of plasma cystatin C (CysC) in patients with acute coronary syndrome (ACS) after pereutaneous 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 coronary artery checked by coronary angiography and successful PCI; (2) normal renal function or mild dysfunction with glomerular filtration rate (GFR) ＞ 60 ml/ ( min · 1.73 m2 ).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＜1.02 mg/L),Q2 (1.02 mg/L≤＜CysC ＜1.17 mg/ L),Q3 (1.17 mg/L ≤ CysC ＜1.35 mg/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 x2.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 ≥3 were the risk factors of poor prognosis (P ＜ 0.05 ).④ Multivarite 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 Q1.⑤　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.
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