半胱氨酸蛋白酶抑制物C在心力衰竭的临床意义

目的观察慢性心力衰竭患者血清半胱氨酸蛋白酶抑制物C的变化及其临床意义。方法心力衰竭60例．心功能正常对照患者30例，测定半胱氨酸蛋白酶抑制物C、血肌酐、血尿素氮、血尿酸浓度，与左心室射血分数、左心室舒张末内径进行相关分析，并随访半年。结果半胱氨酸蛋白酶抑制物C水平在血尿素氮、血肌酐、血尿酸正常的心力衰竭患者高于对照组（P〈O．01），与左心室射血分数呈负相关（r=--O．288，P〈O．05），与左心室舒张末内径呈正相关（r=O．561，P〈O．01）；在心力衰竭患者中，半胱氨酸蛋白酶抑制物C大于1mg／L病人因心力衰竭加重而再住院率明显高于半胱氨酸蛋白酶抑制物C不大于1mg／L病人（P=0．039）。结论无原发性肾脏病变的心力衰竭患者存在早期的肾功能异常，半胱氨酸蛋白酶抑制物C不但是反映心力衰竭患者早期肾功能损伤的敏感指标，而且也是心力衰竭患者预后的重要危险因素。

Clinical significance of serum cystatin C in patients with chronic heart failure

Objectives To investigate the clinical significance of serum cystatin C in patients with chronic heart failure （CHF）. Methods Serum cystatin C, serum creatinine （Scr）, blood urea nitrogen （BUN） and blood uric acid （BUA） were determined in 60 patients with CHF and in 30 control subjects without CHF. Correlation analysis was performed between cystatin C and left ventricular ejection fraction （LVEF） or left ventricular end diastolic dimension （LVEDd）. All patients with CHF were followed-up for half one year. Results Serum levels of cystatin C in CHF patients with normal BUN, Scr and BUA were higher than those in control subjects （P〈0.01）. Cystatin C was correlated negatively to LVEF （r=-0.288, P 〈0.05） and correlated positively to LVEDd （r= 0.561, P〈0.01）. The rehospitalization rate due to progressive heart failure was markerly higher in patients with elevated cystatin C level （more than 1 mg/L） than in patients with normal cystatin C levels （less than 1 rag/L） （P=0.039）. Conclusions In early abnormality of renal function in CHF patients without primary renal disorder, cystatin C is a novel and sensitive index of early renal function impairment. Elevation of serum cystatin is able to find high risk patients with CHF.