本文選題：血清胱抑素C + 心力衰竭�。� 參考：《吉林大學》2013年碩士論文

【摘要】：背景與目的：心力衰竭（Heart failure，HF）仍然是世界范圍內導致死亡的主要原因之一。慢性腎臟疾病作為心力衰竭的獨立危險因素，，尤其對于那些合并其他心血管危險因素者或者已患有心血管疾病的患者，已得到越來越多的關注。血清胱抑素C (cystatin C，Cys C)是近些年來發(fā)現(xiàn)的用于評估腎臟早期功能損傷的血清標志物，對腎小球濾過率(Glomerular filtration rate，GFR)的早期輕微的改變的檢測較血清肌酐（serum creatinine，Scr）和尿素氮（urea nitrogen，BUN）更為敏感[1]。近年來國內外臨床研究發(fā)現(xiàn)高Cys C水平增加老年冠心病的全因死亡率、心血管死亡率及心力衰竭的發(fā)生率[2]，而這種風險不能完全被Scr、BUN所預測[3]。Cys C與心血管疾病的發(fā)生、發(fā)展及預后有關。本研究通過檢測心力衰竭患者血清Cys C水平的變化，探討Cys C表達水平與患者近期（6個月內）預后的關系，并應用血清CysC水平的變化評價短期（6個月）應用血管緊張素轉換酶抑制劑治療對患者腎功能的影響。 方法：本研究選取2011年11月—2012年9月期間于吉林大學中日聯(lián)誼醫(yī)院心內科住院的心力衰竭患者81例，其中女性39例，男性42例，年齡41～85歲，缺血性心臟病44例，高血壓性心臟病12例，擴張型心肌病11例，瓣膜病14例，心功能按紐約心臟病協(xié)會（NYHA）分級，NYHA I~II級13例，NYHA III級29例，NYHA IV級39例。同時選取同期就診于我院的健康體檢者81例作為對照組。詳細記錄患者年齡、性別、體重、身高、收縮壓和舒張壓，所有入選患者入院后24小時內采取空腹靜脈血，測定血清胱抑素C（Cys C）以及空腹血糖、總膽固醇、低密度脂蛋白膽固醇、腦鈉肽（BNP）、血肌酐（Scr）、尿素氮(BUN)，并通過超聲心動圖測定左室射血分數(shù)（LVEF）。所有入選患者都接受平均6個月的隨訪，通過門診定期復查、電話詢問及病例查詢等方式，記錄患者住院期間以及出院6個月內發(fā)生的主要心血管事件（心功能惡化、伴血流動力學障礙的心律失常、再發(fā)心肌梗死、伴心電圖缺血改變的心絞痛）、任何原因死亡和再入院率[4]，并比較應用ACEI類藥物治療前后的尿素氮、肌酐、血清CysC的水平變化。本研究所有數(shù)據(jù)均采用統(tǒng)計學軟件SPSS17.0進行分析，計數(shù)資料以均數(shù)±方差表示，計量資料以例數(shù)（百分比）表示，多組比較采用單因素方差分析，組間兩樣本均數(shù)比較采用t檢驗，相關性分析采用直線相關分析；p0.05為差異有統(tǒng)計學意義。 研究結果：和對照組相比，心衰組患者的Cys C水平明顯升高，且隨心功能級別增高，Cys C濃度顯著升高，2組血清肌酐及尿素氮水平變化無顯著性差異（p0.05）；擴張型心肌病引起的心衰與缺血性心肌病引起的心衰患者相比血清Cys C表達水平有統(tǒng)計學差異（p0.05），其他病因的心衰患者血清Cys C水平無差異（p0.05）；Cys C水平與左室射血分數(shù)（LVEF）、收縮壓、舒張壓及腦鈉肽（BNP）的相關性分析,顯示發(fā)現(xiàn)血清Cys C與LVEF呈負相關（r=-0.551,p0.01），CysC與收縮壓呈負相關（r=-0.361，p=0.01），Cys C與舒張壓呈負相關（r=-0.391，p=0.008），Cys C與BNP呈正相關（r=0.374，p0.01）；高Cys C組（Cys C≥1.75mg/L）與低Cys C組(Cys C1.75mg/L)比較，顯示高Cys C組患者的6個月內全因死亡率、主要心血管事件發(fā)生率、6個月內再入院率都明顯高于低Cys C組，兩者差異有統(tǒng)計學意義(p 0.01)。平均隨訪6個月，心血管不良事件的患者的Cys C水平明顯高于好轉患者，兩者比較差異有統(tǒng)計學意義（p0.05）。應用ACEI藥物治療6個月后尿素氮、肌酐、血清Cys C水平較治療前均有所下降，其中尿素氮、肌酐的濃度差異無統(tǒng)計學意義，而血清Cys C的濃度差異有統(tǒng)計學意義。 結論： 1、Cys C的水平可反映心衰患者早期腎臟功能的受損，在腎功能正�；蜉p微受損的心衰患者中，Cys C對全因死亡率及主要心血管事件方面的預測價值優(yōu)于其他經典的標志物，如肌酐及BNP水平，對心力衰竭有較好的預后價值。 2、在評價心衰程度上血清CysC的水平與BNP、LVEF有較好的相關性。 3、在評價ACEI藥物治療6個月后腎功能變化上血清Cys C較尿素氮、肌酐更敏感。
[Abstract]:Background and purpose: Heart failure (HF) is still one of the major causes of death worldwide. Chronic renal disease is an independent risk factor for heart failure, especially for those with other cardiovascular risk factors or patients who have been suffering from cardiovascular disease. Somatostatin C (cystatin C, Cys C) is a serum marker used to assess early renal impairment in the kidney. The detection of early minor changes in the glomerular filtration rate (Glomerular filtration rate, GFR) is more sensitive than serum creatinine (serum creatinine, Scr) and urinary nitrogen (Cys) in recent years. The study found that high Cys C levels increase the total cause of mortality, cardiovascular mortality and the incidence of heart failure [2], but this risk can not be completely Scr, BUN predicts that [3].Cys C is related to the occurrence, development and prognosis of cardiovascular disease. This study is to explore Cys C by detecting the changes in serum Cys C levels in patients with heart failure. The relationship between the expression level and the prognosis of the patients (6 months) and the changes of serum CysC level were used to evaluate the effect of angiotensin converting enzyme inhibitor therapy on renal function in the short term (6 months).
Methods: This study selected 81 patients with heart failure hospitalized in Department of Cardiology, China Japan Friendship Hospital, Jilin University from November 2011 to September 2012, including 39 women, 42 males, 41~85 years of age, 44 cases of ischemic heart disease, 12 cases of hypertensive heart disease, 11 cases of dilated cardiomyopathy, 14 valvular disease, cardiac function according to New York heart disease association. NYHA grade, NYHA I~II grade 13 cases, NYHA III grade 29 cases, NYHA IV grade 39 cases, and 81 cases of healthy physical examination in our hospital at the same time were selected as control group. The patient's age, sex, weight, height, systolic pressure and diastolic pressure were recorded in detail, and all the selected patients took fasting venous blood within 24 hours after admission to determine serum cystatin C (Cys C). With fasting blood glucose, total cholesterol, low density lipoprotein cholesterol, brain natriuretic peptide (BNP), serum creatinine (Scr), urea nitrogen (BUN) and echocardiography, the left ventricular ejection fraction (LVEF) was measured by echocardiography. All the selected patients were followed up for an average of 6 months. The major cardiovascular events occurring within 6 months of discharge (cardiac deterioration, arrhythmia with hemodynamic disorders, recurrent myocardial infarction, angina pectoris with electrocardiogram), any cause of death and readmission rate [4], were compared with the changes in urea nitrogen, creatinine, and serum CysC levels before and after the treatment of ACEI. All of this study The data were analyzed with statistical software SPSS17.0, the count data were expressed in mean number of variance, and the measured data were represented by the number of cases (percentage). The multiple groups were compared by single factor analysis of variance. The average number of two samples in the group was compared with t test, and the correlation analysis was analyzed by linear correlation analysis, and the difference of P0.05 was statistically significant.
Results: compared with the control group, the level of Cys C in the patients with heart failure was significantly higher, and the level of cardiac function increased, the concentration of Cys C increased significantly. There was no significant difference in serum creatinine and urea nitrogen levels in the 2 groups (P0.05). The serum Cys C expression water was compared with the heart failure caused by dilated cardiomyopathy and ischemic cardiomyopathy. There was no difference in statistical difference (P0.05), and there was no difference in serum Cys C levels in patients with other causes of heart failure (P0.05); the correlation analysis of Cys C level with left ventricular ejection fraction (LVEF), systolic pressure, diastolic pressure and brain natriuretic peptide (BNP) showed that serum Cys C and LVEF were negatively correlated with LVEF (r=-0.551 and BNP). The diastolic pressure was negatively correlated (r=-0.391, p=0.008), Cys C was positively correlated with BNP (r=0.374, P0.01), and the high Cys C group (Cys C > 1.75mg/L) showed the total cause of mortality within 6 months, the incidence of major cardiovascular events and the rate of readmission within 6 months were significantly higher than those of the low Cys group. The study significance (P 0.01). The average follow-up of 6 months of follow-up, the level of Cys C in patients with adverse cardiovascular events was significantly higher than that of the improved patients. The difference was statistically significant (P0.05). After 6 months of ACEI drug treatment, the levels of urea nitrogen, creatinine, and serum Cys C were lower than those before the treatment. There was no statistical difference in the concentration difference between urea nitrogen and creatinine. The difference in serum Cys C concentration was statistically significant.
Conclusion:
1, the level of Cys C can reflect the impairment of early renal function in patients with heart failure. In patients with normal or slight impaired renal failure, the predictive value of Cys C to all causes and major cardiovascular events is superior to other classic markers, such as creatinine and BNP levels, which have good prognostic value for heart failure.
2, there was a good correlation between serum CysC level and BNP and LVEF in evaluating the degree of heart failure.
3, the serum Cys C was more sensitive than urea nitrogen and creatinine after renal function changes after 6 months of ACEI treatment.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R541.6

【參考文獻】

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