慢性心力衰竭患者血清内源性Apela，NT-proBNP及CysC水平与并发肾功能不全的相关性分析

目的　探讨血清内源性 Apela，氨基末端脑钠肽前体（ N-terminal pro-B type natriuretic peptide, NT-proBNP）及胱抑素 C（cystatin C, Cys C）在慢性心力衰竭（chronic heart failure, CHF）中的表达及与并发肾功能不全的相关性分析。方法　选择 2017年 1月～ 2019年 12月于榆林市第二医院就诊的慢性心力衰竭患者 200例作为研究对象，并根据患者肾功能分为肾功能正常组（ n=92）和肾功能不全组（ n=108），采用全自动生化分析仪检测患者血清肌酐（ creatinine， Cr）和尿素氮（ blood urea nitrogen, BUN）含量，采用酶联免疫吸附法试剂盒检测患者血清中 NT-proBNP,Apela及 Cys C含量，并根据 Cr水平计算肾小球滤过率（ eGFR），比较两组间差异，并采用 Logistic回归分析筛选慢性心力衰竭并发肾功能不全的危险因素，绘制 ROC曲线判断 NT-proBNP,Apela和 Cys C对慢性心力衰竭并发肾功能不全的预测价值。结果　肾功能正常组左心室射血分数（ left ventricular ejection fraction，LVEF）明显高于肾功能不全组（ 48.95%±5.56 % vs 44.16%±7.18%），心功能分级明显优于肾功能不全组 ,差异均有统计学意义（ t=7.360，P＜ 0.001；χ2=9.067， P=0.026）。两组患者性别、年龄、病程、 BMI和基础心脏病情况差异均无统计学意义（均 P＞ 0.05）。肾功能不全组 BUN（8.23±2.78mmol/L），Cr（269.78±21.90μmol/L），NT-proBNP（6 064.12±163.81pg/ml），Cys C（1.68±0.03mg/ L）和 Apela（1.29±0.42 ng/L）大于肾功能正常组 (3.16±1.29 mmol/L, 73.90±13.46μmol/L, 3 157.21±180.38pg/ml, 0.74± 0.05 mg/L, 0.76±0.47ng/L)，eGFR（42.38±9.31 ml/min/1.73m2）小于肾功能正常组（110.92±16.68ml/min/1.73m2）, 差异均有统计学意义（ t=23.948，109.414, 168.840, 223.092, 11.908，49.550，均 P＜ 0.001）。Logistic回归分析结果显示: LVEF，心功能分级、 BUN, Cr, NT-proBNP, eGFR, Cys C以及 Apela均是慢性心力衰竭并发肾功能不全的危险因素（均 OR＞ 1，P＜ 0.05）。NT-proBNP,Apela和 Cys C诊断慢性心力衰竭并发肾功能不全 AUC分别为 0.605，0.708，0.626，特异度分别为 0.642，0.658，0.694，敏感度分别为 0.618，0.731，0.714;三者联合诊断慢性心力衰竭并发肾功能不全的 AUC为 0.747，特异度和敏感度分别为 0.762，0.737。结论　NT-proBNP, Cys C和 Apela是慢性心力衰竭并发肾功能不全的危险因素，且三者联合诊断价值较高，对于临床诊断和治疗有一定的参考价值。

Correlation Analysis of Serum Endogenous Apela,NT-proBNP,Cys C Levels and Renal Insufficiency in Patients with Chronic Heart Failure

Objective　To investigate the expression of serum endogenous Apela，N-terminal pro-B type natriuretic peptide （NT-proBNP）and cystatin C（Cys C）in chronic heart failure（CHF） and the correlation between them and renal insufficiency. Methods　Two hundred patients with CHF who were treated at the Second Hospital of Yulin City from January 2017 to December 2019 were selected as the research objects.They were divided into normal renal function group (n=92) and incomplete renal function group (n=108 ). Automatic biochemical analyzer was used to detect the content of creatinine (Cr) and urea nitrogen (BUN) in patients, and the enzyme-linked immunosorbent assay kit was used to detect the levels of NT-proBNP， Apela and Cys C in the patient’s serum. Glomerular filtration rate (eGFR) was calculated based on Cr level, and the differences between the two groups were compared. Logistic regression analysis was used to screen the risk factors of CHF with renal insufficiency, and ROC curve was drawn to judge the predictive value of NT-proBNP, Apela and Cys C in CHF with renal insufficiency. Results　Left ventricular ejection fraction（LVEF） of normal renal function group was significantly higher than that of renal insufficiency group（48.95%±5.56 % vs 44.16%±7.18%），and heart function grade was significantly better than that of renal insufficiency group，the difference was statistically significant （t=7.360，P ＜ 0.001；χ2=9.067，P=0.026）. There was no significant difference in gender, age, course of disease, BMI and basic heart disease between the two groups (all P ＞ 0.05). BUN（8.23±2.78mmol/L），Cr（269.78±21.90 μmol/L），NT-proBNP（6 064.12±163.81pg/ml），Cys C （1.68±0.03mg/L）and Apela（1.29±0.42 ng/L）in renal insufficiency group were higher than those in normal renal function group(3.16±1.29 mmol/L,73.90±13.46μmol/L, 3 157.21±180.38pg/ml,0.74±0.05 mg/L,0.76±0.47ng/L), and eGFR （42.38±9.31 ml/min/1.73m2）was lower than those in normal renal function group（110.92±16.68ml/min/1.73m2），the differences were statistically significant（t=23.948，109.414, 168.840, 223.092, 11.908, 49.550，all P ＜ 0.001）. Logistic regression analysis showed that LVEF, heart function grade, BUN, Cr, NT-proBNP, eGFR, Cys C and Apela were the risk factors of CHF with renal insufficiency(all OR >1，P < 0.05). The AUC of NT-proBNP,Apela and Cys C in the diagnosis of CHF with renal insufficiency were 0.605, 0.708 and 0.626, respectively. The specificity was 0.642, 0.658 and 0.694, respectively. The sensitivity was 0.618, 0.731 and 0.714, respectively. The AUC of the combined diagnosis of CHF with renal insufficiency was 0.747, and the specificity and sensitivity were 0.762 and 0.737, respectively. Conclusion　NT-proBNP, Cys C and Apela are the risk factors of CHF with renal insufficiency, and the combined diagnosis of the three factors is of high value, which has a certain reference value for clinical diagnosis and treatment.