Taglieri Nevio, Koenig Wolfgang, Kaski Juan Carlos
Cardiovascular Biology Research Centre, Division of Cardiac and Vascular Sciences, St George's University of London, London, UK.
Ann Biol Clin (Paris). 2010 Sep-Oct;68(5):517-29. doi: 10.1684/abc.2010.0466.
Patients with chronic kidney disease (CKD) are at high risk for developing cardiovascular disease (CVD) and cardiovascular events. Cystatin C, a protease inhibitor synthesized in all nucleated cells, has been proposed as a replacement for serum creatinine for the assessment of renal function, particularly to detect small reductions in glomerular filtration rate. This report presents a review of the role of cystatin C as a predictor of cardiovascularis. Patients with higher circulating cystatin C concentrations appear to have an increased cardiovascular risk profile, i.e., they are older and have a higher prevalence of systemic hypertension, dyslipidemia, documented CVD, increased body mass index, and increased concentrations of C-reactive protein. Prospective studies have shown, in various clinical scenarios, that patients with increased cystatin C are at a higher risk of developing both CVD and CKD. Importantly, cystatin C appears to be a useful marker or identifying individuals at a higher risk of cardiovascular events among patients belonging ot a relatively lox-risk category as assessed by both creatinine and estimated glomerular filtration rate values. Of interest, elastolytic proteases and their inhibitors, in particular cystatin C, have been shown to be directly involved in the atherosclerotic process. Increases concentrations of cystatin C appear to be indicative of preclinical kidney disease associated with adverse outcomes. Clinical studies involving direct glomerular filtration rate measurements are required to ascertain both the true role of this promising marker in renal disease and whether atherogenic factors like inflammation can account for increases in cystatin C concentrations, thus explaining its predictive value in CVD.
慢性肾脏病（CKD）患者发生心血管疾病（CVD）及心血管事件的风险很高。胱抑素C是一种在所有有核细胞中合成的蛋白酶抑制剂，已被提议作为血清肌酐的替代指标用于评估肾功能，尤其是检测肾小球滤过率的轻微降低。本报告对胱抑素C作为心血管疾病预测指标的作用进行了综述。循环中胱抑素C浓度较高的患者似乎具有更高的心血管疾病风险特征，即他们年龄更大，系统性高血压、血脂异常、确诊的CVD、体重指数增加以及C反应蛋白浓度升高的患病率更高。前瞻性研究表明，在各种临床情况下，胱抑素C升高的患者发生CVD和CKD的风险更高。重要的是，对于那些根据肌酐和估算肾小球滤过率值评估属于相对低风险类别的患者，胱抑素C似乎是一个有用的标志物，可用于识别心血管事件风险较高的个体。有趣的是，弹性蛋白酶及其抑制剂，特别是胱抑素C，已被证明直接参与动脉粥样硬化过程。胱抑素C浓度升高似乎表明与不良后果相关的临床前期肾脏疾病。需要进行涉及直接测量肾小球滤过率的临床研究，以确定这一有前景的标志物在肾脏疾病中的真正作用，以及炎症等致动脉粥样硬化因素是否可解释胱抑素C浓度升高，从而解释其在CVD中的预测价值。
