McManus David, Shlipak Michael, Ix Joachim H, Ali Sadia, Whooley Mary A
Cardiology Division, University of Massachusetts, Worcester, MA, USA.
Am J Kidney Dis. 2007 Mar;49(3):365-72. doi: 10.1053/j.ajkd.2006.12.016.
Cystatin C, an alternative serum measure of kidney function, is a stronger predictor of cardiovascular events than creatinine or estimated glomerular filtration rate (eGFR). We hypothesized that serum cystatin C concentration would have a stronger more linear association with cardiovascular functional status than creatinine-based measures in outpatients with established coronary heart disease (CHD).
We measured serum cystatin C, serum creatinine, and eGFR in 906 outpatients with established CHD. We examined the association of these 3 measures of kidney function with treadmill exercise capacity (metabolic equivalent tasks achieved) and heart rate recovery (HRR) between peak and 1 minute after exercise by using linear and logistic regression.
Higher cystatin C concentrations were associated linearly with worse treadmill exercise capacity and HRR. The proportion of participants with poor exercise capacity (metabolic equivalent tasks achieved < 5) was 45% (99 of 222 participants) among those with cystatin C levels in the highest quartile (>1.30 mg/L) compared with 12% (29 of 241 participants) among those with cystatin C levels in the lowest quartile (<0.92 mg/L; adjusted odds ratio, 3.2; 95% confidence interval, 1.6 to 6.5; P = 0.001). The proportion of participants with poor HRR (<16 beats/min) was 42% (92 of 214 participants) among those with cystatin C levels in the highest quartile compared with 16% (37 of 238 participants) among those with cystatin C levels in the lowest quartile (adjusted odds ratio, 2.2; 95% confidence interval, 1.2 to 4.0; P = 0.01). The lowest quartile of eGFR (<61.8 mL/min [<1.03 mL/s]) was associated with decreased exercise capacity and prolonged HRR, but no difference was observed across the upper 3 quartiles of eGFR.
In patients with established CHD, cystatin C concentrations are associated linearly with worse exercise capacity and HRR. Cystatin C detects an association of impaired kidney function with decreased HRR and exercise capacity that is not fully captured using creatinine-based measurements.
胱抑素C作为肾功能的一种替代血清指标，在预测心血管事件方面比肌酐或估算肾小球滤过率（eGFR）更强。我们假设，在已确诊冠心病（CHD）的门诊患者中，血清胱抑素C浓度与心血管功能状态的关联比基于肌酐的指标更强且更呈线性。
我们对906例已确诊CHD的门诊患者测量了血清胱抑素C、血清肌酐和eGFR。我们通过线性和逻辑回归分析了这3种肾功能指标与跑步机运动能力（达到的代谢当量任务）以及运动高峰后1分钟内心率恢复（HRR）之间的关联。
较高的胱抑素C浓度与较差的跑步机运动能力和HRR呈线性相关。在胱抑素C水平处于最高四分位数（>1.30 mg/L）的参与者中，运动能力差（达到的代谢当量代谢当量任务<5）的比例为45%（222名参与者中的99名），而在胱抑素C水平处于最低四分位数（<0.92 mg/L）的参与者中这一比例为12%（241名参与者中的29名）；校正比值比为3.2；95%置信区间为1.6至6.5；P = 0.001。在胱抑素C水平处于最高四分位数的参与者中，HRR差（<16次/分钟）的比例为42%（214名参与者中的92名），而在胱抑素C水平处于最低四分位数的参与者中这一比例为16%（238名参与者中的37名）；校正比值比为2.2；95%置信区间为1.2至4.0；P = 0.01。eGFR的最低四分位数（<61.8 mL/min [<1.03 mL/s]）与运动能力下降和HRR延长相关，但在eGFR的上三分位数之间未观察到差异。
在已确诊CHD的患者中，胱抑素C浓度与较差的运动能力和HRR呈线性相关。胱抑素C检测到肾功能受损与HRR降低和运动能力下降之间的关联，而基于肌酐的测量未能完全捕捉到这种关联。
