4型心肾综合征患者血清肌钙蛋白I、N末端B型利钠肽原、胱抑素C水平变化及应用价值

李皇庆; 欧阳运峰; 阳军

doi:10.3969/j.issn.1671-2390.2023.10.005

4型心肾综合征患者血清肌钙蛋白I、N末端B型利钠肽原、胱抑素C水平变化及应用价值

Changes and clinical values in serum levels of cardiac troponin I, cystatin C and N-terminal B-type natriuretic propeptide in patients with type 4 cardiorenal syndrome

摘要

摘要:
目的探讨血清肌钙蛋白I（cardiac troponin I，cTnI）、N末端B型利钠肽原（N-terminal B-type natriuretic propeptide，NT-proBNP）和胱抑素C（cystatin C，CysC）水平在诊断4型心肾综合征（cardiorenal syndrome，CRS）中的应用价值及其与心功能的关系。
方法回顾性分析2020年4月至2022年4月因慢性肾脏病（chronic kidney disease，CKD）于湖南师范大学附属第一医院（湖南省人民医院）肾内科住院的患者，其中符合纳入标准的92例4型CRS患者为CRS组，另88例为CKD组。收集并比较两组间、不同心功能患者间血清cTnI、NT-proBNP、CysC水平和心脏功能指标等水平变化，分析血清cTnI、NT-proBNP、CysC水平与4型CRS患者心功能严重程度的相关性及应用价值。
结果 CRS组患者cTnI0.026（0.013，0.062）μg/L比0.010（0.005，0.021）μg/L、NT-proBNP15 292.0（2971.0，35 000.0）μg/L比498.7（335.4，1318.8）μg/L、CysC（4.48±1.73）mg/L比（3.33±1.58）mg/L、舒张末期左心室内径（48.26±9.42）mm比（45.65±5.28）mm、舒张末期室间隔厚度（11.52±1.76）mm比（10.38±1.37）mm和左心室后壁舒张末期厚度（11.27±1.61）mm比（10.21±1.29）mm明显高于CKD组，左室射血分数（45.56±9.33）%比（55.46±5.93）%明显低于CKD组（P＜0.05）。随着心功能分级的升高，CRS组患者血清cTnI、NT-proBNP及CysC水平明显增高，且呈正相关（r=0.543、0.766、0.421，P＜0.001）；左室射血分数明显下降，呈负相关（r=−0.469，P＜0.001）。检测血清cTnI、NT-proBNP和CysC诊断4型CRS的曲线下面积（area under curve，AUC）分别为0.778（95%CI：0.710～0.846）、0.920（95%CI：0.880～0.961）、0.707（95%CI：0.630～0.784），三者联合诊断的AUC为0.924（95%CI：0.885～0.962）。
结论 4型CRS患者cTnI、NT-proBNP、CysC水平与心功能等级呈正相关，cTnI和CysC水平对4型CRS具有一定的诊断价值，NT-proBNP是诊断和评估4型CRS的敏感、精确的指标。

Abstract:
Objective To explore the clinical values of serum levels of cardiac troponin I (cTnI), cystatin C (CysC) and N-terminal B-type natriuretic propeptide (NT-proBNP) in patients with type IV cardiorenal syndrome (CRS) and examine their correlations with cardiac function.
Methods From April 2020 to April 2022, thr relevant clinical data were retrospectively reviewed for 92 hospitalized patients of type IV CRS due to chronic renal insufficiency (CKD). Another 88 patients were selected as CKD group. The levels of cardiac troponin-I (cTnI), N-terminal B-type natriuretic propeptide (NT-proBNP), cystatin C (CysC) and echocardiographic results were collected and compared between two groups and those with different concentric functions.
Results In CRS group, the levels of cTnI 0.026(0.013, 0.062)μg/L vs 0.010(0.005, 0.021)μg/L, NT-proBNP 15 292.0(2971.0, 35 000.0)μg/L vs 498.7(335.4, 1318.8)μg/L and CysC (4.48±1.73)mg/L vs (3.33±1.58)mg/L, left ventricular end diastolic dimension (48.26±9.42)mm vs (45.65±5.28)mm, interventricular septal thickness at end-diastole (11.52±1.76)mm vs (10.38±1.37)mm, left ventricular posterior wall thickness at end-diastole (11.27±1.61)mm vs (10.21±1.29)mm were significantly higher than those in nephrotic group. Meanwhile left ventricular ejection fraction in CRS group were lower than those in nephrotic group (45.56±9.33)% vs (55.46±5.93%), P<0.05. With worsening cardiac function, serum levels of cTnI, NT-proBNP and CysC spiked markedly and correlated positively (r=0.543, 0.766, 0.421, P<0.001) while LVEF declined significantly and correlated negatively (r=−0.469, P<0.001). The area under curve (AUC) of serum levels of cTnI, NT-proBNP and CysC for type 4 CRS was 0.778 (95%CI:0.710-0.846), 0.920(95%CI:0.880-0.961) and 0.707(95%CI:0.630-0.784) respectively while AUC of combining the above three was 0.924(95%CI:0.885-0.962).
Conclusions Serum levels of cTnI, NT-proBNP and CysC in patients with type IV CRS are correlated positively with cardiac function. And cTnI and CysC may aid the diagnosis of type IV CRS and NT-proBNP is a sensitive and accurate biomarker.

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