半胱氨酸蛋白酶抑制剂C对老年慢性充血性心力衰竭患者早期肾功能的临床评价

目的 探讨半胱氨酸蛋白酶抑制剂C(cystatin C)对评价老年慢性充血性心力衰竭(CHF)患者早期肾损害的临床价值.方法 检测年龄≥65岁的慢性CHF患者(CHF组,60例)、心功能代偿期的心脏病患者(心功能代偿组,40例)及健康对照者(对照组,20例)的cystatin C水平,并与脑钠肽(BNP)以及LVEF进行相关性分析.结果 CHF组cystatin C水平(1.86±0.37)mg/L]明显高于心功能代偿组(1.32±0.56)mg/L]及对照组(1.05±0.43)mg/L],P<0.01.cystatin C水平与BNP水平呈正相关(r=0.528,P<0.01),与LVEF呈负相关(r=-0.463,P<0.01).CHF组中BNP≥500ng/L者较BNP<500ng/L者cystatin C水平升高,且肾衰竭发生率增加.结论 cystatin C检测适用于老年慢性CHF患者早期肾损害的诊断.心力衰竭程度越重,肾小球滤过功能损害越明显,cystatin C水平越高.

Clinical evaluation of early impairment of renal function in elderly patients with chronic heart failure by detecting serum cystatin C

Objective To investigate the clinical value of serum cystatin C in the early renal function impairment in elderly patients wtih chronic congestive heart failure (CHF). Methods Serum cystafin Cwas measured in 60 cases with chronic CHF (CHF group), 40 cases with cardiovascular diseases and compensated heart function (compensated heart function group), and other 20 elderly normal volunteers(controlgroup). The correlation between cystafin C, B-type natriuretic peptide (BNP) and LVEF was evaluated. Results The levels of eystatin C in CHF group (1.86±0.37)mg/L]was higher than that in compensated heart function group (1.32±0.56) mg/L]and control group (1.05±0.43) mg/L], P < 0.01. Cystatin C was positively correlated with BNP (r = 0.528,P< 0.01)and negatively correlated with LVEF (r=-0.463, P<0.01). In CHF group, the level of cystatin C and the incidence rate of renal failure was higher in the patients with BNP≥500 ng/L than those with BNP < 500 ng/L. Conclusions Cystatin C is a marker dearly impairment of renal function in elderly patients with chronic CHF. The more severe the heart failure, the more obvious the glomorular filtration function impairment shows.