血清胱抑素C水平与急性冠脉综合征患者短期预后的相关性研究

摘要：目的 探讨急性冠脉综合症（ACS）患者血清胱抑素C(Cys-C)水平与短期预后的关系。方法 入选2010年1月1日至2014年10月31日在中国医科大学附属盛京医院住院并行PCI介入治疗的ACS患者970例，检测纳入研究患者临床资料及冠脉病变情况，并记录所有患者住院期间及出院后30天内主要不良心血管事件(MACE)发生情况。结果 根据ROC曲线确定Cys-C界值为1.45并以此将患者分为高Cys-C组和低Cys-C组。高Cys-C组年龄水平、高血压病史人数占比、Cr值、NLR值、BNP值、GRACE评分、冠脉三支病变占比、Gensini评分均较高，差异均有显著统计学意义（P＜0.01）。多因素分析显示Cys-C 、GRACE评分、CK是MACE发生的危险因素。高Cys-C组患者全因死亡率及心源性死亡率显著升高(P< 0．001)。Cys-C水平ROC曲线下面积与GRACE评分相比较，两者之间无统计学意义的差异性（P=0.247)。结论 ACS患者血清Cys-C水平可作为短期预后的评估指标，较高的Cys-C水平为此类患者全因死亡及心源性死亡的独立危险因素。且Cys-C水平对ACS患者短期预后的预测能力与GRACE评分接近。可强化Cys-C监测，对水平较高者应加强随访和预后干预。

Correlation between serum cystatin C level and GRACE score and short-term prognosis in patients with acute coronary syndrome

[Abstract] Objective To investigate the relationship between serum cystatin C(cys-c) level and short-term prognosis in patients with acute coronary syndrome (ACS). Methods A total of 970 ACS patients admitted to shengjing hospital affiliated to China medical university on January 1, 2010 and October 31, 2014 for PCI interventional treatment were included. The clinical data and coronary artery lesions of the included patients were examined, and the occurrence of major adverse cardiovascular events (MACE) during hospitalization and within 30 days after discharge were recorded. Results According to the ROC curve, the cys-c threshold was determined to be 1.45, and the patients were divided into high cys-c group and low cys-c group.In the group with high cys-c, age level, proportion of hypertension history, Cr value, NLR value, BNP value, GRACE score, proportion of coronary artery disease, and Gensini score were all higher, with statistically significant differences (P < 0.01).Multivariate analysis showed that CysC, GRACE score and CK were risk factors for MACE.All-cause mortality and cardiogenic mortality were significantly higher in the high cys-c group (P< 0.001).There was no statistically significant difference between the area under the ROC curve of cys-c level and the GRACE score (P=0.247).Conclusion The serum cys-c level in ACS patients can be used as an indicator for short-term prognosis, and the higher cys-c level is an independent risk factor for all-cause death and cardiogenic death in such patients.Moreover, the predictive power of cys-c level for short-term prognosis of ACS patients was close to that of GRACE score.Cys-c monitoring can be strengthened, and prognostic intervention should be strengthened for patients with higher level.