Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Science for Life Laboratory, Uppsala University, Uppsala, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden.
Atherosclerosis. 2014 May;234(1):108-13. doi: 10.1016/j.atherosclerosis.2014.02.020. Epub 2014 Feb 28.
Urinary cystatin C (u-CysC) is a new biomarker for acute tubular kidney dysfunction and may also indicate chronic tubular dysfunction. Chronic kidney disease is an important cardiovascular risk factor, however it is not known if u-CysC is a risk marker for cardiovascular death.
The association between u-CysC and cardiovascular mortality was investigated in a Swedish community-based cohort of 604 men aged 78 years. During follow-up (mean 6.7 years), 203 participants died, of which 90 due to cardiovascular causes.
High u-CysC (>0.029 mg/mmol Cr) was associated with a more than 2-fold risk of cardiovascular death (multivariable hazard ratio for quintile 5 vs. 1: 2.5, 95% CI 1.2-5.2, P < 0.05) in Cox regression models independent of cardiovascular risk factors, glomerular filtration rate (eGFR) and urinary Albumin. Participants with low eGFR (≤60 mL/min), albuminuria (≥3 mg/mmol Cr) and high u-CysC (>0.029 mg/mmol Cr) combined had a significantly higher cardiovascular mortality risk compared to participants with one or two of these biomarkers normal (hazard ratio 15, 95% CI: 6.7-36, P < 0.001, compared to all three biomarkers normal).
This study is the first to show that increased concentrations of the tubular kidney biomarker u-CysC indicated risk of cardiovascular death independently of other cardiovascular risk factors, glomerular filtration and albuminuria. Additional research is needed to further establish the usefulness of u-CysC in clinical practice.
尿胱抑素 C（u-CysC）是急性肾小管功能障碍的新型生物标志物，也可能提示慢性肾小管功能障碍。慢性肾脏病是心血管疾病的重要危险因素，但尚不清楚 u-CysC 是否是心血管死亡的风险标志物。
本研究在一个瑞典社区为基础的 604 名 78 岁男性队列中研究了 u-CysC 与心血管死亡率之间的关系。在随访期间（平均 6.7 年），有 203 名参与者死亡，其中 90 人死于心血管原因。
在 Cox 回归模型中，高 u-CysC（>0.029mg/mmol Cr）与心血管死亡风险增加 2 倍以上相关（五分位数 5 与 1 的比值比：2.5，95%CI 1.2-5.2，P<0.05），该模型独立于心血管危险因素、肾小球滤过率（eGFR）和尿白蛋白。与具有一个或两个正常生物标志物（危险比 15，95%CI：6.7-36，P<0.001，与所有三个正常生物标志物相比）的参与者相比，同时具有低 eGFR（≤60mL/min）、白蛋白尿（≥3mg/mmol Cr）和高 u-CysC（>0.029mg/mmol Cr）的参与者的心血管死亡率风险显著更高。
本研究首次表明，肾小管肾生物标志物 u-CysC 浓度的增加独立于其他心血管危险因素、肾小球滤过率和白蛋白尿，预示着心血管死亡的风险。需要进一步的研究来进一步确定 u-CysC 在临床实践中的有用性。
