胱抑素C对急性冠脉综合征PCI术预后判断.docVIP

胱抑素C对急性冠脉综合征PCI术预后判断【摘要】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）60 ml/（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24 h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（CysC60 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 (CysC1.02 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 χ2. 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 (P0.001). The rates of mortality, nonfatal myocardial infarction and target lesion revascularization in Q4 were higher than those in Q1 (P0.05). The incidences of heart failure in Q3 and Q4 were higher than that in Q1 (P0.05). ③Univariate analysis demonstrated that CysC, creatinine, LVEF, age, history of PCI and NYHA grade ≥3 were the risk factors of poor pr