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目的探讨左室射血分数保留心力衰竭(heart failure with preserved ejection fraction,HFpEF)老年患者血清胱抑素C(cystatin C,CysC)的表达及其与NYHA心功能分级的关系。方法老年HFpEF患者90例为HFpEF组,同期住院心功能正常老年患者79例为对照组,测定2组血浆N末端B型脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)水平,血清CysC肌酐、尿素氮、尿酸水平,超声心动图检测左室射血分数(left ventricular ejection faction,LVEF);采用Spearman相关法分析血清CysC与血浆NT-proBNP、LVEF的相关性;绘制ROC曲线分析血清CysC诊断HFpEF的效能。结果HFpEF组血浆NT-proBNP[2 145.00(863.75,4 493.25)ng/L],血清CysC[(1.84±0.83)mg/L]、肌酐[(107.04±56.81)μmol/L]、尿素氮[(7.96±3.94)mmol/L]、尿酸[(429.93±132.14)μmol/L]水平均高于对照组[91.00(63.00,132.00)ng/L、(1.20±0.43)mg/L、(75.50±22.76)μmol/L、(5.63±1.75)mmol/L、(343.13±99.94)μmol/L],LVEF水平[(55.31±7.89)%]低于对照组[(65.78±3.79)%](P<0.05);随NYHA心功能分级增加,血清CysC、血浆NT-proBNP水平逐渐升高,LVEF逐渐降低(P<0.05);校正肌酐、尿素氮、尿酸等因素后,血清CysC与血浆NT-proBNP呈正相关(r=0.336,P=0.002),与LVEF呈负相关(r=-0.214,P=0.048);血清CysC为1.345mg/L时,诊断HFpEF的AUC为0.761(95%CI:0.688~0.834,P<0.001),灵敏度为75.6%,特异度为74.7%。结论老年HFpEF患者血清CysC水平高于心功能正常人群,且其水平与NYHA心功能分级密切相关,对HFpEF的诊断有一定价值。
Objective To investigate the expression of cystatin C (CysC) in elderly patients with heart failure and preserved ejection fraction (HFpEF) and its relationship with NYHA functional class. Methods 90 elderly patients with HFpEF were treated with HFpEF and 79 elderly patients with normal cardiac function were enrolled in the study. Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) Serum CysC creatinine, blood urea nitrogen and uric acid were measured. The left ventricular ejection fraction (LVEF) was measured by echocardiography. The correlation between serum CysC and plasma NT-proBNP and LVEF was analyzed by Spearman’s correlation. Curve analysis of serum CysC to diagnose the efficacy of HFpEF. Results The levels of plasma NT-proBNP [2 145.00 (863.75, 4993.25) ng / L], serum CysC [(1.84 ± 0.83) mg / L] and creatinine [(107.04 ± 56.81) (4.96 ± 3.43) mmol / L] and uric acid [(429.93 ± 132.14) μmol / L) were significantly higher than those in the control group [91.00 ± 63.00,132.00 ng / L, ), LVEF level (55.31 ± 7.89%) was lower than that of control group (65.78 ± 3.79%) (P <0.05) ). The level of serum CysC and plasma NT-proBNP gradually increased and the LVEF decreased gradually with NYHA functional class (P <0.05). Corrected serum creatinine, urea nitrogen, uric acid and other factors had a positive correlation between serum CysC and plasma NT-proBNP (r = -0.214, P = 0.048). When serum CysC was 1.345mg / L, the AUC of HFpEF diagnosis was 0.761 (95% CI: 0.688-0.834, P <0.001), the sensitivity was 75.6% and the specificity was 74.7%. Conclusions The level of serum CysC in elderly patients with HFpEF is higher than that of normal people with normal heart function, and its level is closely related to the grading of NYHA cardiac function. It has some value in the diagnosis of HFpEF.