CAJ | 학술논문

目的：研究半胱氨酸蛋白酶抑制剂C（Cys C）与急性冠状动脉综合征（ACS）患者近期预后的关系。方法选择ACS患者386例，其中ST 抬高型ACS（STE-ACS）患者212例、非ST 抬高型ACS（NSTE-ACS）患者174例。检测入院24 h内ACS患者血清B型钠尿肽（BNP）、高敏C 反应蛋白（hs-CRP）、Cys C、心肌肌钙蛋白I （cTnI）浓度。将Cys C按百分位数间距分组，采用秩和检验比较BNP、hs-CRP、年龄、体重在不同组间的差异以及STE-ACS和NSTE-ACS 患者中的Cys C浓度差异。采用χ2检验比较高血压、糖尿病、高血脂、吸烟在不同组间的分布差异。随访入选病例住院期间和出院后18个月内心血管事件的发生情况，比较不同组别人群心血管事件累计发生率，绘制ACS患者心血管事件累计发生率对时间Kaplan-Meier曲线以及Cys C预测近期心血管不良事件发生的受试者工作特征（ROC）曲线。结果根据血清Cys C百分位数间距将ACS患者分为＜0．69 mg/L组（96例）、0．69～＜0．86 mg/L组（97例）、0．86～＜1．03 mg/L组（98例）和≥1．03 mg/L组（95例）。随着Cys C百分位数间距的增高，年龄、BNP、hs-CRP水平以及高血压、糖尿病、高血脂的分布率不断增高；体重、吸烟在各组中的分布率没有明显差异。STE-ACS组与NSTE-ACS组间血清Cys C浓度差异无统计学意义（P＞0．05）。18个月内由低到高的不同 Cys C 浓度组对应的心血管事件累计发生率依次增高，分别为6．3％、7．2％、9．2％、18．9％；Kaplan-Meier曲线显示，≥1．03 mg/L组与＜0．69 mg/L组之间差异有统计学意义（P＜0．05）。Cys C预测近期心血管不良事件发生的ROC曲线下面积为0．754。结论 Cys C水平与心血管风险因子BNP、hs-CRP、年龄、高血压、糖尿病、高血脂呈正相关，对预测ACS患者近期不良心血管事件发生具有一定意义，预测性与ACS的类型无关。目的：研究半胱氨痠蛋白酶抑製劑C（Cys C）與急性冠狀動脈綜閤徵（ACS）患者近期預後的關繫。方法選擇ACS患者386例，其中ST 抬高型ACS（STE-ACS）患者212例、非ST 抬高型ACS（NSTE-ACS）患者174例。檢測入院24 h內ACS患者血清B型鈉尿肽（BNP）、高敏C 反應蛋白（hs-CRP）、Cys C、心肌肌鈣蛋白I （cTnI）濃度。將Cys C按百分位數間距分組，採用秩和檢驗比較BNP、hs-CRP、年齡、體重在不同組間的差異以及STE-ACS和NSTE-ACS 患者中的Cys C濃度差異。採用χ2檢驗比較高血壓、糖尿病、高血脂、吸煙在不同組間的分佈差異。隨訪入選病例住院期間和齣院後18箇月內心血管事件的髮生情況，比較不同組彆人群心血管事件纍計髮生率，繪製ACS患者心血管事件纍計髮生率對時間Kaplan-Meier麯線以及Cys C預測近期心血管不良事件髮生的受試者工作特徵（ROC）麯線。結果根據血清Cys C百分位數間距將ACS患者分為＜0．69 mg/L組（96例）、0．69～＜0．86 mg/L組（97例）、0．86～＜1．03 mg/L組（98例）和≥1．03 mg/L組（95例）。隨著Cys C百分位數間距的增高，年齡、BNP、hs-CRP水平以及高血壓、糖尿病、高血脂的分佈率不斷增高；體重、吸煙在各組中的分佈率沒有明顯差異。STE-ACS組與NSTE-ACS組間血清Cys C濃度差異無統計學意義（P＞0．05）。18箇月內由低到高的不同 Cys C 濃度組對應的心血管事件纍計髮生率依次增高，分彆為6．3％、7．2％、9．2％、18．9％；Kaplan-Meier麯線顯示，≥1．03 mg/L組與＜0．69 mg/L組之間差異有統計學意義（P＜0．05）。Cys C預測近期心血管不良事件髮生的ROC麯線下麵積為0．754。結論 Cys C水平與心血管風險因子BNP、hs-CRP、年齡、高血壓、糖尿病、高血脂呈正相關，對預測ACS患者近期不良心血管事件髮生具有一定意義，預測性與ACS的類型無關。
목적：연구반광안산단백매억제제C（Cys C）여급성관상동맥종합정（ACS）환자근기예후적관계。방법선택ACS환자386례，기중ST 태고형ACS（STE-ACS）환자212례、비ST 태고형ACS（NSTE-ACS）환자174례。검측입원24 h내ACS환자혈청B형납뇨태（BNP）、고민C 반응단백（hs-CRP）、Cys C、심기기개단백I （cTnI）농도。장Cys C안백분위수간거분조，채용질화검험비교BNP、hs-CRP、년령、체중재불동조간적차이이급STE-ACS화NSTE-ACS 환자중적Cys C농도차이。채용χ2검험비교고혈압、당뇨병、고혈지、흡연재불동조간적분포차이。수방입선병례주원기간화출원후18개월내심혈관사건적발생정황，비교불동조별인군심혈관사건루계발생솔，회제ACS환자심혈관사건루계발생솔대시간Kaplan-Meier곡선이급Cys C예측근기심혈관불량사건발생적수시자공작특정（ROC）곡선。결과근거혈청Cys C백분위수간거장ACS환자분위＜0．69 mg/L조（96례）、0．69～＜0．86 mg/L조（97례）、0．86～＜1．03 mg/L조（98례）화≥1．03 mg/L조（95례）。수착Cys C백분위수간거적증고，년령、BNP、hs-CRP수평이급고혈압、당뇨병、고혈지적분포솔불단증고；체중、흡연재각조중적분포솔몰유명현차이。STE-ACS조여NSTE-ACS조간혈청Cys C농도차이무통계학의의（P＞0．05）。18개월내유저도고적불동 Cys C 농도조대응적심혈관사건루계발생솔의차증고，분별위6．3％、7．2％、9．2％、18．9％；Kaplan-Meier곡선현시，≥1．03 mg/L조여＜0．69 mg/L조지간차이유통계학의의（P＜0．05）。Cys C예측근기심혈관불량사건발생적ROC곡선하면적위0．754。결론 Cys C수평여심혈관풍험인자BNP、hs-CRP、년령、고혈압、당뇨병、고혈지정정상관，대예측ACS환자근기불양심혈관사건발생구유일정의의，예측성여ACS적류형무관。
Objective To study the relationship of cystatin C (Cys C)concentration with short term prognosis in acute coronary syndrome (ACS)patients. Methods A total of 386 ACS patients were enrolled,including 212 patients with ST elevation ACS (STE-ACS)and 1 74 patients with non-ST elevation ACS (NSTE-ACS).Serum B-type natriuretic peptide (BNP),high sensitive C reactive protein (hs-CRP),Cys C and cardiac troponin I (cTnI)were determined within 24h after admission.Serum Cys C was classified according to percentile intervals.Rank-sum test was used to compare the levels of BNP,hs-CRP,age and weight in the different groups and the differences of Cys C concentrations in the STE-ACS and NSTE-ACS groups.χ2 test was used to compare the distribution differences of hypertension,diabetes mellitus,high cholesterol and smoking in the different groups.The cardiovascular events of the selected patients during hospitalization and after discharge were followed up. The cumulative incidence rates of cardiovascular events were compared among the different groups,Kaplan-Meier curves of cumulative incidence rates of cardiovascular events to time were drawn,and receiver operating characteristic (ROC)curve was drawn to assess Cys C predictive adverse outcome in patients with ACS.Results According to Cys C concentration percentile intervals,the ACS patients were classified into <0.69 mg/L group (96 patients),0.69-<0.86 mg/L group (97 patients),0.86-<1 .03 mg/L group (98 patients)and≥1 .03 mg/L group (95 patients).The age,BNP and hs-CRP also increased in the different groups,as well as the distributions of hypertension,diabetes mellitus and high cholesterol.Weight and smoking distributions in each group had no significant difference.Cys C concentration in STE-ACS group had no statistical significance with that in NSTE-ACS (P>0.05 ).The cumulative incidence rates of cardiovascular events in the different groups were 6.3%,7.2%,9.2% and 1 8.9% from low-concentration Cys C to high-concentration Cys C respectively,but there was statistical significance between ≥1 .03 mg/L group and <0.69 mg/L group,according to Kaplan-Meier curves (P <0.05 ).The area under ROC curve predicting the risk of adverse outcome was 0.754. Conclusions Cys C concentration is positively correlated with BNP,hs-CRP,age,hypertension,diabetes mellitus and high cholesterol,and it contributes particularly in predicting the adverse outcome in patients with ACS,with no interaction by the type of ACS.