血清胱抑素C在硬皮病心脏受累患者中的表达及临床意义

    Expression and clinical significance of serum cystatin C in patients with cardiac involvement in scleroderma

      摘要
    • 摘要:
      目的  探讨血清胱抑素C在硬皮病心脏受累患者中的表达及可能的临床意义。
      方法  回顾性收集2018年1月～2024年3月在空军军医大学第二附属医院唐都医院就诊的103例硬皮病患者，根据是否存在心脏受累，分为心脏受累组（44例），心脏未受累组组（59例），比较两组患者的临床特征、实验室指标，采用多因素Logistic回归，分析总结合并心脏受累的危险因素，采用受试者工作特征（receiver operator characteristic, ROC）曲线评估血清胱抑素C对硬皮病患者心脏受累的预测价值。
      结果 心脏受累组患者的肺动脉高压发生率高于心脏未受累组（P<0.01）；心脏受累组患者Cys-c1.6 (1.2, 1.9) vs. 1.0 (0.9, 1.2), P< 0.01、ESR24 (18, 34) vs. 18 (12, 30)，P<0.05水平均高于心脏未受累组，血红蛋白（HGB）(113 ± 18) vs. (125 ± 15)， P< 0.01、高密度脂蛋白（HDL）0.9 (0.8, 1.1) vs. 1.1 (1.0, 1.3)， P<0.01水平均低于心脏未受累组，差异均有统计学意义。Logistic回归分析结果显示：肺动脉高压、血清胱抑素C是硬皮病患者心脏受累的独立危险因素（P<0.05），高密度脂蛋白是心脏受累的独立保护因素（P<0.05）。血清胱抑素C预测硬皮病患者心脏受累的曲线下面积为0.820（95%CI：0.738, 0.902），当血清胱抑素C临界值取1.065 mg/L时，其判断价值最高，敏感度86.4%，特异度62.7%。
      结论  血清胱抑素C是硬皮病患者心脏受累的独立危险因素，血清胱抑素C可以很好的预测硬皮病患者的心脏受累情况。

       

      Abstract:
      AIM To investigate the expression and possible clinical significance of serum cystatin C in patients with cardiac involvement in scleroderma.
      METHODS One hundred and three scleroderma patients who visited Tangdu Hospital, the Second Affiliated Hospital of Air Force Medical University, from January 2018 to March 2024 were selected and divided into an involved group (44 cases) and an uninvolved group (59 cases) according to the presence of cardiac involvement. The patients’ clinical data were retrospectively analyzed and the clinical characteristics and laboratory indexes of the two groups were compared. Multifactorial logistic regression was used to analyze the risk factors for cardiac involvement and the predictive value of serum cystatin C for cardiac involvement in patients with scleroderma was assessed using receiver operator characteristic (ROC) curve.
      RESULTS The incidence of pulmonary arterial hypertension in patients with heart involvement was higher than that in patients without heart involvement, and the difference was statistically significant (P<0.01); The levels of Cys-c 1.6 (1.2, 1.9) vs. 1.0 (0.9, 1.2), P<0.01 and ESR 24 (18, 34) vs. 18 (12, 30), P<0.05 were higher in the heart affected group than in the heart unaffected group. The levels of hemoglobin (HGB) (113 ± 18) vs. (125 ± 15), P<0.01 and high-density lipoprotein (HDL) 0.9 (0.8, 1.1) vs. 1.1 (1.0, 1.3), P<0.01 were lower in the heart unaffected group, and the differences were statistically significant. The results of logistic regression analysis showed that pulmonary arterial hypertension and serum cystatin C were independent risk factors for cardiac involvement in patients with scleroderma (P<0.05), while high-density lipoprotein was an independent protective factor for cardiac involvement (P<0.05). The area under the curve for predicting cardiac involvement in patients with scleroderma using serum cystatin C is 0.820 (95% CI: 0.738, 0.902). When the critical value of serum cystatin C is set at 1.065 mg/L, its diagnostic value is highest, with a sensitivity of 86.4% and a specificity of 62.7%.
      CONCLUSION Serum cystatin C is an independent risk factor for cardiac involvement in patients with scleroderma and serum cystatin C can well predict the cardiac involvement in patients with scleroderma.

       

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