CAJ | 학술논문

目的：评价B型脑钠肽（B-type natriuretic peptide）联合血清胱抑素C(Serum cystatin C，CysC)在陈旧性心肌梗死患者中临床意义。方法连续入选2013年1~11月我院收治的陈旧性心肌梗死患者244例，根据NYHA分级标准评价患者心功能，分为非心衰组(NYHA心功能Ⅰ级)、心衰组(NYHA心功能Ⅱ~Ⅳ级)。入院后记录患者性别、年龄、高血压病、糖尿病、心肌梗死类型、NYHA分级等一般资料。入院即刻测定CysC、BNP水平，两周内测定左室舒张末内径(LVEDD)、左室射血分数(LVEF)。结果两组患者在性别、高血压、糖尿病、LDL-C等方面比较，差异均无统计学意义(P>0.05)。与非心衰组比较，心衰组年龄偏大，陈旧性前壁心肌梗死比率高，血清CysC水平升高，BNP水平升高，左室舒张末内径大，左室射血分数比较低，差异有统计学意义(P<0.01)。相关分析显示，胱抑素C与LVEF呈直线相关(P<0.01)。二项Logistic回归分析显示，血清Cys C (OR=12.51，P=0.000)、陈旧性前壁心肌梗(OR=3.857，P=0.000)、年龄(OR=3.272，P=0.000)是陈旧性心肌梗死发生心力衰竭的相关危险因素。结论陈旧性心肌梗死患者CysC对心力衰竭具有很好的预测价值，BNP联合CysC可进一步评价患者血流动力学状态。
목적：평개B형뇌납태（B-type natriuretic peptide）연합혈청광억소C(Serum cystatin C，CysC)재진구성심기경사환자중림상의의。방법련속입선2013년1~11월아원수치적진구성심기경사환자244례，근거NYHA분급표준평개환자심공능，분위비심쇠조(NYHA심공능Ⅰ급)、심쇠조(NYHA심공능Ⅱ~Ⅳ급)。입원후기록환자성별、년령、고혈압병、당뇨병、심기경사류형、NYHA분급등일반자료。입원즉각측정CysC、BNP수평，량주내측정좌실서장말내경(LVEDD)、좌실사혈분수(LVEF)。결과량조환자재성별、고혈압、당뇨병、LDL-C등방면비교，차이균무통계학의의(P>0.05)。여비심쇠조비교，심쇠조년령편대，진구성전벽심기경사비솔고，혈청CysC수평승고，BNP수평승고，좌실서장말내경대，좌실사혈분수비교저，차이유통계학의의(P<0.01)。상관분석현시，광억소C여LVEF정직선상관(P<0.01)。이항Logistic회귀분석현시，혈청Cys C (OR=12.51，P=0.000)、진구성전벽심기경(OR=3.857，P=0.000)、년령(OR=3.272，P=0.000)시진구성심기경사발생심력쇠갈적상관위험인소。결론진구성심기경사환자CysC대심력쇠갈구유흔호적예측개치，BNP연합CysC가진일보평개환자혈류동역학상태。
Objective To evaluate the predictive value of serum cystatin C (CysC) and B-type natriuretic peptide (BNP) in patients with old myocardial infarction. Methods A total of 244 patients with old myocardial in-farction in our hospital from Jan. 2013 to Nov. 2013 were included, which were divided into non-heart failure group (NYHA classⅠ) and heart failure group (NYHA classⅡ~Ⅳ). The general data of patients at admission, includinggender, age, hypertension, diabetes, type of myocardial infarction, NYHA classification, were recorded. The level of Cys C, BNP, left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) were ob-served. Results There was no statistically significant difference between the two groups in gender, hypertension, dia-betes, LDL-C (P>0.05). Compared with non-heart failure group, the level of Cys C, BNP, mean age, rate of anterior wall myocardial infarction in heart failure group were all significantly higher (P<0.05). The LVEDD in the heart fail-ure group were larger, and LVEF were lower (P<0.01). Correlation analysis indicated that there was linear correlation between Cys C and LVEF (P<0.01). Logistic regression analysis indicated that Cys C (OR=12.51, P=0.000), old ante-rior myocardial infarction (OR=3.857, P=0.000) and age (OR=3.272, P=0.000) were the independent risk factors of heart failure in patients with old myocardial infarction. Conclusion Cys C could predict heart failure in patients with old myocardial infarction, and BNP combined with CysC can further evaluate the hemodynamic status of the patients.