胱抑素 C 与代谢综合征的相关性及其在肾功能正常的非 ST 段抬高型急性冠状动脉综合征中的预后价值。
Association of Cystatin C with Metabolic Syndrome and Its Prognostic Performance in Non-ST-Segment Elevation Acute Coronary Syndrome with Preserved Renal Function.
机构信息
Department of Cardiovascular Medicine, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing 400037, China.
Department of Occupational Health, Army Medical University, Chongqing 400038, China.
出版信息
Biomed Res Int. 2019 Jun 16;2019:8541402. doi: 10.1155/2019/8541402. eCollection 2019.
OBJECTIVE
The underlying mechanisms by which cystatin C affects cardiovascular disease (CVD) are not very clear. Metabolic syndrome (MetS) is a cluster of risk factors that increase the risk of CVD. Here, we aimed to investigate the association of cystatin C with metabolic syndrome and cardiovascular outcomes in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) with preserved renal function.
METHODS
In total, 422 NSTE-ACS patients with preserved renal function were enrolled to examine the association of cystatin C with MetS. MetS was defined based on the NCEP-ATP-III guidelines. Major adverse cardiovascular events (MACEs) were also evaluated, which included cardiac death, nonfatal myocardial infarction (MI), target vessel revascularization (TVR), heart failure, and nonfatal stroke. All patients underwent a 12-month follow-up for MACEs after admission.
RESULTS
Cystatin C was significantly correlated with metabolic risk factors and inflammation markers. The prevalence of MetS and MACEs correlated with cystatin C levels. Cystatin C showed a strong diagnostic performance for cardiovascular risk factors and outcomes in ROC analysis. After adjustment for multiple risk factors, cystatin C level was independently associated with MetS (OR 2.299, 95% CI 1.251-4.225, and P = 0.007). During a 12-month follow-up, the patients with high cystatin C level and MetS had higher incidence of MACEs (Log-rank = 24.586, P < 0.001) and cardiac death (Log-rank = 9.890, P = 0.020) compared to the others. Multivariate Cox analysis indicated that cystatin C level was an independent predictor of MACEs (HR 2.609, 95% CI 1.295-5.257, and P = 0.007).
CONCLUSION
Cystatin C may be an independent predictor of metabolic syndrome and therefore valuable for management of NSTE-ACS patients. Further multicenter, large-scale studies are required to assess the implication of these results.
目的
胱抑素 C 影响心血管疾病（CVD）的潜在机制尚不清楚。代谢综合征（MetS）是一组增加 CVD 风险的危险因素。在这里，我们旨在研究胱抑素 C 与肾功能正常的非 ST 段抬高急性冠状动脉综合征（NSTE-ACS）患者代谢综合征和心血管结局之间的关系。
方法
共纳入 422 例肾功能正常的 NSTE-ACS 患者，以检验胱抑素 C 与 MetS 的关系。MetS 是根据 NCEP-ATP-III 指南定义的。主要不良心血管事件（MACE）也进行了评估，包括心脏死亡、非致死性心肌梗死（MI）、靶血管血运重建（TVR）、心力衰竭和非致死性卒中。所有患者在入院后进行了 12 个月的 MACE 随访。
结果
胱抑素 C 与代谢危险因素和炎症标志物显著相关。MetS 和 MACE 的患病率与胱抑素 C 水平相关。ROC 分析显示，胱抑素 C 对心血管危险因素和结局具有较强的诊断性能。在校正多个危险因素后，胱抑素 C 水平与 MetS 独立相关（OR 2.299，95%CI 1.251-4.225，P = 0.007）。在 12 个月的随访期间，高胱抑素 C 水平和 MetS 的患者发生 MACEs（Log-rank = 24.586，P < 0.001）和心脏死亡（Log-rank = 9.890，P = 0.020）的发生率高于其他患者。多变量 Cox 分析表明，胱抑素 C 水平是 MACEs 的独立预测因子（HR 2.609，95%CI 1.295-5.257，P = 0.007）。
结论
胱抑素 C 可能是代谢综合征的独立预测因子，因此对 NSTE-ACS 患者的管理具有重要价值。需要进一步进行多中心、大规模研究来评估这些结果的意义。
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