摘要： 目的 观察血清胱抑素C对慢性心力衰竭远期预后的预测价值。方法 连续收集中国医科大学附属盛京医院心血管内科2013年1月至2018年12月4 965例心力衰竭住院患者的临床资料。其中，心功能Ⅱ级1 080例，Ⅲ级2 367例，Ⅳ级1 518例。在院死亡204例（4.1%），全因死亡1 783例（35.9%）。平均随访3.2年（2~8年），以全因死亡为终点。通过单因素及多因素Cox生存分析、Kaplan-Meier分析、受试者操作特征（ROC）曲线，研究血清胱抑素C对慢性心力衰竭的远期预后的预测价值。结果 血清胱抑素C值越高，重度心功能不全比例越高，院内死亡率及远期死亡率也明显升高；多因素Cox分析剔除其他混杂因素干扰后，高胱抑素C组远期死亡风险是低胱抑素C组的1.989倍（95% CI：1.391~2.843，P < 0.001）。ROC曲线约登指数确定胱抑素C预测远期死亡发生的最佳界值是1.63 mg/L，曲线下面积0.686，灵敏度54%，特异度76%。结论 血清胱抑素C是慢性心力衰竭患者远期死亡的独立危险因素，对心力衰竭患者远期预后具有较好的预测价值。

血清胱抑素C对慢性心力衰竭远期预后的预测价值

王力¹, 王传合², 韩苏², 佟菲², 孙志军²

1. 大连医科大学附属大连市中心医院心内科, 辽宁 大连 116033;
2. 中国医科大学附属盛京医院心血管内科, 沈阳 110022

收稿日期:2021-05-07出版日期:2021-12-30发布日期:2021-12-09
通讯作者:孙志军E-mail:sunzj@sj-hospital.org
作者简介:王力(1980-),男,副主任医师,博士研究生.
基金资助:辽宁省自然科学基金（2018225003）


关键词: 慢性心力衰竭, 血清胱抑素C, 预后
Abstract: Objective To determine the predictive value of serum cystatin C on the long-term prognosis of chronic heart failure patients. Methods The study included 4 965 patients who were hospitalized for heart failure from January 2013 to December 2018 in the Department of Cardiology，Shengjing Hospital of China Medical University. A total of 1 080，2 367，and 1 518 patients had heart failure functional class Ⅱ，Ⅲ，and Ⅳ （NYHA functional classification），respectively. Hospital deaths resulted from 204 （4.1%） patients，while all-cause mortality resulted from 1 783 （35.9%）. Patients were followed up for an average of 3.2 years （2 to 8 years），with all-cause mortality as the primary endpoint of the study. Univariate Cox analysis and multivariate Cox survival analysis were done. Kaplan-Meier curve and receiver operating characteristic （ROC） curve were also utilized to determine the predictive value of serum cystatin C on the long-term prognosis of chronic heart failure. Results Patients with higher serum cystatin C values had increased proportions of severe cardiac insufficiency as well as in-hospital mortality，and long-term mortality. After eliminating other confounding factors，such as the homocystatin C group，through multivariate Cox analysis，the long-term mortality risk was 1.989 times higher than that of the hypocystatin C group （95% CI：1.391-2.843，P < 0.001）. The Youden index of ROC curve determined the best cut-off value for cystatin C that predicts the occurrence of long-term death was at 1.63 mg/L. The area under the curve was 0.686，the sensitivity was 54%，and the specificity was 76%. Conclusion Serum cystatin C is an independent risk factor for long-term mortality in patients with chronic heart failure. Furthermore，it has a good predictive value on the long-term prognosis of patients with chronic heart failure.
Key words: chronic heart failure, serum cystatin C, prognosis
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