Pérez-Calvo Juan I, Sánchez-Marteles Marta, Ruiz-Ruiz Francisco-José, Morales-Rull José-Luis, Nieto-Rodríguez José-Antonio
Servicio de Medicina Interna, Hospital Clínico Universitario 'Lozano Blesa' , Zaragoza , Spain.
JRSM Short Rep. 2010 Oct 21;1(5):44. doi: 10.1258/shorts.2010.010059.
To determine whether serum Cystatin C (CysC) and NTproBNP have prognostic value among patients with long-standing chronic lung disease.
Prospective, observational, non-interventional study.
CysC and NTproBNP are prognostic markers in several cardiac conditions. In addition, CysC acts as an antiprotease following Cathepsin activation, which has been involved in the pathogenesis of chronic obstructive pulmonary disease.
Patients with a basal functional status of II-IV (NYHA), admitted for an acute exacerbation of chronic pulmonary diseases and no previous history of symptoms related to pulmonary hypertension or heart failure.
NTproBNP and CysC were determined at admission in 107 patients with acute exacerbation of chronic lung disease. During 12-month follow-up, mortality, new hospital admissions and prescription of diuretics were recorded.
During follow-up there were eight patient deaths (7.5%). Mean NTproBNP among the deceased was 1510.20 pg/mL (95% CI 498.44-4628.55) vs 502.70 pg/mL (95% CI 395.44-645.48) among survivors (p = 0.01). Twenty-seven patients (25%) were prescribed loop diuretics. Mean concentration of CysC was 1.45 mg/dL (95% CI 1.21-1.69 mg/dL) vs 1.17 mg/dL (95% IC 1.09-1.25 mg/dL) in those not prescribed (p = 0.004). NTproBNP concentration was 837.14 pg/mL (95% CI 555.57-1274.10 pg/mL) in patients prescribed diuretics vs 473.42 pg/mL (95% CI 357.80-632.70 pg/mL) in those not prescribed (p = 0.03). Kaplan-Meier analysis revealed a significant difference between death and diuretic prescription during follow-up when cut-off value for NTproBNP was 550 pg/mL (p = 0.03 and p = 0.02, respectively). For 1.16mg/dL of CsysC, a significant difference was only observed in diuretic prescription (p = 0.007).
In patients with chronic respiratory diseases NTproBNP has predictive value in terms of mortality whereas CysC does not. However, it is still possible that both can contribute to the early identification of patients at risk of developing clinical ventricular dysfunction.
确定血清胱抑素C（CysC）和N末端脑钠肽前体（NTproBNP）在长期慢性肺病患者中是否具有预后价值。
前瞻性、观察性、非干预性研究。
CysC和NTproBNP是几种心脏疾病的预后标志物。此外，CysC在组织蛋白酶激活后作为一种抗蛋白酶发挥作用，而组织蛋白酶激活已参与慢性阻塞性肺疾病的发病机制。
基础功能状态为II-IV级（纽约心脏协会分级）的患者，因慢性肺病急性加重入院，且既往无肺动脉高压或心力衰竭相关症状史。
对107例慢性肺病急性加重患者入院时测定NTproBNP和CysC。在12个月的随访期间，记录死亡率、再次入院情况和利尿剂处方。
随访期间有8例患者死亡（7.5%）。死亡患者的NTproBNP平均水平为1510.20 pg/mL（95%置信区间498.44 - 4628.55），而存活患者为502.70 pg/mL（95%置信区间395.44 - 645.48）（p = 0.01）。27例患者（占25%）接受了袢利尿剂治疗。接受利尿剂治疗患者的CysC平均浓度为1.45 mg/dL（95%置信区间1.21 - 1.69 mg/dL），未接受治疗患者为1.17 mg/dL（95%置信区间1.09 - 1.25 mg/dL）（p = 0.004）。接受利尿剂治疗患者的NTproBNP浓度为837.14 pg/mL（95%置信区间555.57 - 1274.10 pg/mL），未接受治疗患者为473.42 pg/mL（95%置信区间357.80 - 632.70 pg/mL）（p = 0.03）。Kaplan-Meier分析显示，当NTproBNP临界值为550 pg/mL时，随访期间死亡和利尿剂处方之间存在显著差异（分别为p = 0.03和p = 0.02）。对于CysC浓度为1.16mg/dL时，仅在利尿剂处方方面观察到显著差异（p = 0.007）。
在慢性呼吸道疾病患者中，NTproBNP对死亡率具有预测价值，而CysC则不然。然而，两者仍有可能有助于早期识别有发生临床心室功能障碍风险的患者。
