Division of Nephrology, Department of Internal Medicine, Pusan National University Hospital School of Medicine, Busan, Republic of Korea.
Clin Exp Nephrol. 2012 Jun;16(3):456-63. doi: 10.1007/s10157-011-0583-1. Epub 2012 Jan 26.
There has been no study to investigate whether cystatin C could predict cardiovascular events in incident dialysis patients. We aimed to delineate the role of serum cystatin C and cystatin C-based estimated glomerular filtration rate (eGFR(cysC)) for prediction of cardiovascular events.
This study included 66 end-stage renal disease patients who survived for >3 months after the start of dialysis, and serum cystain C levels were measured at the point of dialysis initiation.
Serum cystatin C was correlated with blood urea nitrogen (r = 0.537, p < 0.001), serum creatinine (r = 0.480, p < 0.001) and smoking (r = 0.284, p = 0.021). Cystatin C was inversely correlated with age (r = -0.316, p = 0.01) and eGFR(Cr) by modification of diet in renal disease (r = -0.533, p < 0.001). Kaplan-Meier analysis for cardiovascular events revealed that patients in the group with lower cystatin C levels (<4.14 mg/L) had a better event-free survival rate than patients in the group with higher cystatin C levels (≥4.14 mg/L) (p = 0.039). In univariate analysis, cystatin C (hazard ratio (HR) 2.62, p = 0.011) and eGFR(cysC) (HR 0.64, p = 0.004) were significant factors for the prediction of cardiovascular events. After multivariate adjustment, serum cystatin C and eGFR(cysC) were independent determinants of cardiovascular events (HR 3.952, p = 0.001 and HR 0.640, p = 0.004, respectively).
Serum cystatin C might be an independent marker of cardiovascular events in incident dialysis patients. Furthermore, eGFR(cysC) based on measured serum cystatin C could have a new role in predicting cardiovascular events beyond the estimation of true GFR.
目前还没有研究调查胱抑素 C 是否可以预测新开始透析的患者的心血管事件。我们旨在描述血清胱抑素 C 和基于胱抑素 C 的估计肾小球滤过率（eGFR(cysC)）在预测心血管事件中的作用。
本研究纳入了 66 名在开始透析后存活超过 3 个月的终末期肾病患者，并在开始透析时测量血清胱抑素 C 水平。
血清胱抑素 C 与血尿素氮（r = 0.537，p < 0.001）、血清肌酐（r = 0.480，p < 0.001）和吸烟（r = 0.284，p = 0.021）呈正相关。胱抑素 C 与年龄（r = -0.316，p = 0.01）和通过肾脏病饮食改良公式（MDRD）计算的 eGFR（r = -0.533，p < 0.001）呈负相关。心血管事件的 Kaplan-Meier 分析显示，胱抑素 C 水平较低（<4.14mg/L）组的患者无事件生存率高于胱抑素 C 水平较高（≥4.14mg/L）组（p = 0.039）。在单因素分析中，胱抑素 C（危险比（HR）2.62，p = 0.011）和 eGFR(cysC)（HR 0.64，p = 0.004）是预测心血管事件的显著因素。经过多因素调整后，血清胱抑素 C 和 eGFR(cysC)是心血管事件的独立决定因素（HR 3.952，p = 0.001 和 HR 0.640，p = 0.004）。
血清胱抑素 C 可能是新开始透析患者心血管事件的独立标志物。此外，基于实测血清胱抑素 C 的 eGFR(cysC)除了估计真 GFR 外，在预测心血管事件方面可能具有新的作用。
