CAJ | 학술논문

目的：探讨老年冠心病患者血清中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和胱抑素 C （Cys-C）水平与心肾功能关系及其对早期肾损害的诊断价值。方法：选择84例老年冠心病患者，NYHA心功能Ⅰ～Ⅳ级（Ⅰ级组30例、II级组28例、Ⅲ～Ⅳ级组26例），另选择31例老年健康者为健康对照组。测定患者血清 N末端 B型利钠肽原（NT-proBNP）、NGAL和Cys-C等指标，并分析血清 NGAL和 Cys-C水平与 NT-proBNP和估计肾小球滤过率（eGFR）的相关性。应用受试者操作工作特征（ROC）曲线评价血清 NGAL和Cys-C诊断肾功能不全的准确性。结果：健康对照组，NYHAⅠ、II、Ⅲ～Ⅳ级组血清 NGAL [（36.96±21.23）μg/L比（87.80±61.40）μg/L比（141.21±92.96）μg/L比（198.15±98.46）μg/L]和Cys-C [（0.75±0.64）mg/L比（1.40±1.88）mg/L比（2.33±2.03）mg/L比（3.45±1.81）mg/L]水平随着心衰程度加重而升高，以 NYHAⅢ～Ⅳ级组升高最为明显，4组血清 NGAL水平两两比较均有显著性差异（P＜0.01），而血清 Cys-C水平除在 NYHAI级组与健康对照组比较无显著性差异（P＞0.05）外，其余各组两两比较差异均有统计学意义（P＜0.05或＜0.01）。Pearson相关分析显示血清 NGAL和Cys-C水平与 NT-proBNP均呈正相关（r值分别为0.842和0.718，P均＜0.01），与 eGFR均呈负相关（r值分别为-0.689和-0.448，P均＜0.01），且血清NGAL水平与NT-proBNP和eGFR的相关性更密切。血清 NGAL和Cys-C诊断肾功能不全的 ROC曲线下面积分别为0.884和0.744。结论：老年冠心病慢性心力衰竭患者血清 NGAL和Cys-C水平与心肾功能有较好的相关性，是诊断早期肾损害敏感而准确的指标。
목적：탐토노년관심병환자혈청중성립세포명효매상관지질운재단백（NGAL）화광억소 C （Cys-C）수평여심신공능관계급기대조기신손해적진단개치。방법：선택84례노년관심병환자，NYHA심공능Ⅰ～Ⅳ급（Ⅰ급조30례、II급조28례、Ⅲ～Ⅳ급조26례），령선택31례노년건강자위건강대조조。측정환자혈청 N말단 B형리납태원（NT-proBNP）、NGAL화Cys-C등지표，병분석혈청 NGAL화 Cys-C수평여 NT-proBNP화고계신소구려과솔（eGFR）적상관성。응용수시자조작공작특정（ROC）곡선평개혈청 NGAL화Cys-C진단신공능불전적준학성。결과：건강대조조，NYHAⅠ、II、Ⅲ～Ⅳ급조혈청 NGAL [（36.96±21.23）μg/L비（87.80±61.40）μg/L비（141.21±92.96）μg/L비（198.15±98.46）μg/L]화Cys-C [（0.75±0.64）mg/L비（1.40±1.88）mg/L비（2.33±2.03）mg/L비（3.45±1.81）mg/L]수평수착심쇠정도가중이승고，이 NYHAⅢ～Ⅳ급조승고최위명현，4조혈청 NGAL수평량량비교균유현저성차이（P＜0.01），이혈청 Cys-C수평제재 NYHAI급조여건강대조조비교무현저성차이（P＞0.05）외，기여각조량량비교차이균유통계학의의（P＜0.05혹＜0.01）。Pearson상관분석현시혈청 NGAL화Cys-C수평여 NT-proBNP균정정상관（r치분별위0.842화0.718，P균＜0.01），여 eGFR균정부상관（r치분별위-0.689화-0.448，P균＜0.01），차혈청NGAL수평여NT-proBNP화eGFR적상관성경밀절。혈청 NGAL화Cys-C진단신공능불전적 ROC곡선하면적분별위0.884화0.744。결론：노년관심병만성심력쇠갈환자혈청 NGAL화Cys-C수평여심신공능유교호적상관성，시진단조기신손해민감이준학적지표。
Objective:To explore the relationship among serum neutrophil gelatinase associated lipocalin (NGAL), cystatin C (Cys-C) levels and cardiac, renal function;and diagnostic value of NGAL and Cys-C for early renal damage in aged patients With coronary heart disease (CHD).Methods:According to NYHA cardiac function classi-fication,a total of 84 aged CHD patients Were divided into class I group (n=30),class Ⅱ group (n=28)and classⅢ-Ⅳ group (n=26).Another 31 aged healthy objects Were selected as healthy control group.Serum N terminal pro B-type natriuretic peptide (NT-proBNP),NGAL and Cys-C etc. levels Were measured,and the correlation a-mong serum NGAL,Cys-C levels and cardiac function,estimated glomerular filtration rate (eGFR)Were analyzed. The accuracy of serum NGAL and Cys-C diagnosing renal insufficiency Was evaluated by receiver operator character-istic curve (ROC).Results:Along With NYHA class increased,there Were significant increase in serum levels of NGAL [(36.96±21.23)μg/L vs.(87.80±61.40)μg/L vs.(141.21±92.96)μg/L vs.(198.15±98.46)μg/L] and Cys-C [(0.75±0.64)mg/L vs.(1.40±1.88)mg/L vs.(2.33±2.03)mg/L vs.(3.45±1.81)mg/L]in healthy control group,NYHA I,Ⅱ,Ⅲ-Ⅳ groups,and they Were highest in NYHA class Ⅲ-Ⅳ group,there Was significant difference in serum NGAL level betWeen any tWo groups among the four groups (P<0.01),and so Was serum Cys-C level (P<0.05 or <0.01)except healthy control group and NYHA class I group (P>0.05). Pearson correlation analysis indicated that serum NGAL and Cys-C levels Were positively correlated With NT-proBNP (r=0.842,0.718,P<0.01 both),and negatively correlated With eGFR (r=-0.689,-0.448,P<0.01 both), and serum NGAL level had closer correlation With NT-proBNP and eGFR.Area under ROC of serum NGAL and Cys-C Were 0.884 and 0.744 respectively in diagnosing renal insufficiency.Conclusion:Serum NGAL and Cys-C lev-els have good correlation With cardiac and renal function in aged CHD patients,Which are sensitive and accurate in-dexes for diagnosing early renal damage.