Codognotto Marta, Piccoli Antonio, Zaninotto Martina, Mion Monica, Vertolli Ugo, Tona Francesco, Boffa Giovanni M
Division of Nephrology, University Hospital, University of Padova, Padova, Italy.
J Nephrol. 2007 Mar-Apr;20(2):219-27.
Cystatin is an ubiquitous protease inhibitor involved in degradation of cellular proteins and has recently been associated with increased risk of cardiovascular disease and heart failure independent of renal function. We tested whether cystatin in heart failure is only associated with renal function or also with echocardio-Doppler parameters and factors of myocardial remodeling (C-reactive protein, endothelin, and natriuretic peptides).
This was an observational study conducted in 100 adult Caucasian outpatients with NYHA class I-II heart function without diabetes and ischemic heart, 50 with idiopathic dilated cardiomyopathy (DCM) and 50 with uremic cardiomyopathy undergoing hemodialysis (HD). Multiple linear regression analysis was performed on cystatin concentration using clinical, laboratory (creatinine, high sensitivity C-reactive protein, endothelin, B-type natriuretic peptide [BNP]) and echocardio-Doppler data as explanatory variables.
The heart was more severely involved in DCM patients (worse ejection fraction, diastolic volume index, index of myocardial performance, left ventricular mass index). Mean values of cystatin, creatinine, BNP and C-reactive protein in HD compared with DCM patients were 6, 9, 5 and 3 times higher, respectively. Mean values of endothelin were comparable in both groups. Cystatin significantly correlated with creatinine in both groups (r=0.50 in DCM and r=0.37 in HD, and r=0.95 in pooled groups). In the multiple regression analysis, only disease group and creatinine within groups were significant independent factors that accounted for 94% of the variability of cystatin.
Renal function was the determinant of cystatin in a concentration range of 6 times regardless of severity of heart involvement.
胱抑素是一种普遍存在的蛋白酶抑制剂，参与细胞蛋白的降解，最近被认为与心血管疾病和心力衰竭风险增加有关，且与肾功能无关。我们测试了心力衰竭患者体内的胱抑素是否仅与肾功能相关，还是也与超声心动图 - 多普勒参数及心肌重塑因子（C反应蛋白、内皮素和利钠肽）有关。
这是一项观察性研究，纳入了100名纽约心脏协会（NYHA）心功能I-II级、无糖尿病和缺血性心脏病的成年白人门诊患者，其中50例患有特发性扩张型心肌病（DCM），50例正在接受血液透析（HD）的尿毒症心肌病患者。以临床、实验室指标（肌酐、高敏C反应蛋白、内皮素、B型利钠肽[BNP]）以及超声心动图 - 多普勒数据作为解释变量，对胱抑素浓度进行多元线性回归分析。
DCM患者的心脏受累更为严重（射血分数、舒张容积指数、心肌性能指数、左心室质量指数更差）。与DCM患者相比，HD患者的胱抑素、肌酐、BNP和C反应蛋白的平均值分别高出6倍、9倍、5倍和3倍。两组的内皮素平均值相当。两组中胱抑素均与肌酐显著相关（DCM组r = 0.50，HD组r = 0.37，合并组r = 0.95）。在多元回归分析中，只有疾病组和组内肌酐是显著的独立因素，它们占胱抑素变异性的94%。
无论心脏受累的严重程度如何，肾功能都是胱抑素浓度在6倍范围内的决定因素。
