血清Cys-C、β2MG、SCr诊断慢性肾衰竭并发心力衰竭的价值及与心功能分级的关系

尚传波; 陈欣; 陈建国

doi:10.16766/j.cnki.issn.1674-4152.003919

血清Cys-C、β2MG、SCr诊断慢性肾衰竭并发心力衰竭的价值及与心功能分级的关系

doi: 10.16766/j.cnki.issn.1674-4152.003919

1.
芜湖市第一人民医院肾内科，安徽芜湖 241000
2.
合肥市第一人民医院老年医学科，安徽合肥 230061

基金项目:

2020年安徽省自然科学基金项目 2008085MH257

详细信息

通讯作者:
尚传波，E-mail：dg953356@163.com

中图分类号: R692.5 R541.6
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出版历程
- 收稿日期: 2024-01-06
- 网络出版日期: 2025-05-14

The value of serum Cys-C, β2MG and SCr in the diagnosis of chronic renal failure complicated with heart failure and their relationship with cardiac function grading

1.
Department of Nephrology, Wuhu First People ' s Hospital, Wuhu, Anhui 241000, China

摘要

摘要: 目的分析慢性肾衰竭(CRF)并发心力衰竭的诊断中应用血清胱抑素C(Cys-C)、β2微球蛋白(β2MG)、肌酐(SCr)检测的价值，并分析其与患者心功能分级的关系，为临床诊断该疾病提供参考。方法本研究为前瞻性随机对照研究，选取芜湖市第一人民医院2020年1月—2023年7月收治的60例CRF并发心力衰竭患者作为观察组，选取同期60例CRF患者作为单纯CRF组，另选取同期60例健康体检者作为对照组。比较3组研究对象及观察组不同心功能分级患者血清Cys-C、β2MG、SCr水平。采用ROC曲线分析血清Cys-C、β2MG、SCr单独及联合检测诊断CRF并发心力衰竭的价值。采用logistic回归分析研究影响CRF并发心力衰竭患者心功能分级的因素。结果观察组血清Cys-C、β2MG、SCr水平高于单纯CRF组和对照组，单纯CRF组高于对照组(P < 0.05)；观察组心功能Ⅳ级患者血清Cys-C、β2MG、SCr水平均高于Ⅰ级、Ⅱ级、Ⅲ级患者(P < 0.05)。血清Cys-C、β2MG、SCr联合检测诊断CRF并发心力衰竭的AUC值均高于单项检测(Z=4.303、3.843、5.867，均P < 0.05)。Logistic回归分析结果显示，血清Cys-C、β2MG、SCr水平均为CRF并发心力衰竭患者心功能分级的影响因素(P < 0.05)。结论血清Cys-C、β2MG、SCr均为CRF并发心力衰竭患者心功能分级的影响因素，三者联合检测对CRF并发心力衰竭的诊断价值更高。
- 慢性肾衰竭 /
- 心力衰竭 /
- 心功能分级 /
- 胱抑素C /
- β2微球蛋白
Abstract: Objective To analyze the value of serum cystatin C (Cys-C), β2 microglobulin (β2MG) and creatinine (SCr) in the diagnosis of chronic renal failure (CRF) complicated with heart failure, and to analyze their relationship with cardiac function, so as to provide reference for clinical diagnosis of this disease. Methods A total of 60 patients with CRF complicated with heart failure admitted to Wuhu First People ' s Hospital from January 2020 to July 2023 were selected as the observation group, another 60 patients with CRF during the same period were selected as the simple CRF group, and 60 healthy subjects during the same period were selected as the control group. Serum levels of Cys-C, β2MG and SCr were compared between the three groups of subjects and those in the observation group with different cardiac function grades. The value of serum Cys-C, β2MG and SCr alone or combined in the diagnosis of CRF complicated with heart failure was analyzed by ROC curve, and the relationship between serum Cys-C, β2MG and SCr and cardiac function grades was analyzed. Results The serum levels of Cys-C, β2MG and SCr in observation group were higher than those in simple CRF group and control group, and those in simple CRF group were higher than those in control group (P < 0.05). The levels of Cys-C, β2MG and SCr in grade Ⅳ patients were higher than those in grade Ⅰ, grade Ⅱ and grade Ⅲ patients (P < 0.05). The AUC value of serum Cys-C, β2MG and SCr combined detection in the diagnosis of CRF complicated with heart failure was higher than that of single detection (Z=4.303, 3.843, 5.867, all P < 0.05). Logistic regression analysis showed that serum Cys-C, β2MG and SCr levels were the influencing factors of cardiac function classification in patients with CRF complicated with heart failure (P < 0.05). Conclusion Serum Cys-C, β2MG and SCr are the influencing factors of cardiac function classification in patients with CRF complicated with heart failure, and the combined detection of CRF and heart failure has higher diagnostic value.
- Chronic kidney failure /
- Heart failure /
- Cardiac function classification /
- Cystatin C /
- Beta-2 microglobulin

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图 1 血清Cys-C、β2MG、SCr单独及联合检测诊断CRF并发心力衰竭的ROC曲线

Figure 1. ROC curve of serum Cys-C, β2MG and SCr alone and combined in the diagnosis of CRF complicated with heart failure

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表 1 3组研究对象一般资料比较

Table 1. General information of the three groups of subjects

组别	例数	性别[例(%)]		年龄(x ±s，岁)	BMI(x ±s)	受教育程度[例(%)]		收缩压(x ±s，mmHg)
组别	例数	男性	女性	年龄(x ±s，岁)	BMI(x ±s)	高中及以下	专科及以上	收缩压(x ±s，mmHg)
观察组	60	33(55.00)	27(45.00)	75.24±3.35	21.35±1.14	38(63.33)	22(36.67)	130.51±8.28
单纯CRF组	60	31(51.67)	29(48.33)	73.72±4.87	21.48±1.18	35(58.33)	25(41.67)	129.30±8.45
对照组	60	30(50.00)	30(50.00)	73.74±4.51	21.40±1.10	37(61.67)	23(38.33)	125.87±4.33
统计量		0.312^a		2.475^b	0.198^b	0.327^a		0.212^b
P值		0.856		0.087	0.820	0.849		0.141

组别	例数	舒张压(x ±s，mmHg)	中性粒细胞计数(x ±s，×10⁹/L)	淋巴细胞计数(x ±s，×10⁹/L)	血小板计数(x ±s，×10⁹/L)	空腹血糖(x ±s，mmol/L)	总胆固醇(x ±s，mmol/L)	甘油三酯(x ±s，mmol/L)
观察组	60	77.51±8.51	9.22±1.58	1.46±0.55	179.44±20.16	9.48±3.50	4.70±1.52	1.44±0.28
单纯CRF组	60	77.23±8.44	9.48±1.45	1.42±0.53	182.52±20.37	8.72±3.58	4.71±1.50	1.42±0.32
对照组	60	77.11±8.28	9.53±1.22	1.50±0.48	180.52±20.37	6.61±2.22	4.19±1.38	1.40±0.28
统计量		0.036^b	0.819^b	0.354^b	0.356^b	1.822^b	2.462^b	0.278^b
P值		0.965	0.443	0.702	0.701	0.074	0.088	0.758
注：^a为χ²值，^b为F值。1 mmHg=0.133 kPa。

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表 2 3组研究对象血清Cys-C、β2MG、SCr水平比较(x ±s)

Table 2. Comparison of serum levels of Cys-C, β2MG and SCr among the three groups (x ±s)

组别	例数	Cys-C(mg/L)	β2MG(μg/L)	SCr(μmol/L)
观察组	60	2.65±0.32^ab	3 652.22±111.21^ab	456.34±30.78^ab
单纯CRF组	60	2.14±0.22^a	3 242.35±91.15^a	324.28±20.56^a
对照组	60	1.02±0.11	1 862.10±81.26	70.23±10.82
F值		768.214	5 804.002	4 661.035
P值		＜0.001	＜0.001	＜0.001
注：与对照组比较，^aP＜0.05；与单纯CRF组比较，^bP＜0.05。

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表 3 观察组不同心功能分级患者血清Cys-C、β2MG、SCr水平比较(x ±s)

Table 3. Comparison of serum levels of Cys-C, β2MG and SCr among different cardiac function grades in observation group (x ±s)

组别	例数	Cys-C(mg/L)	β2MG(μg/L)	SCr(μmol/L)
心功能Ⅰ级	20	0.86±0.21^a	1 528.86±90.43^a	75.28±7.97^a
心功能Ⅱ级	16	0.92±0.22^a	2 124.52±91.23^a	80.92±6.58^a
心功能Ⅲ级	14	1.28±0.34^a	2 653.84±100.66^a	180.31±20.58^a
心功能Ⅳ级	10	2.34±0.42	3 204.75±110.43	320.44±40.50
F值		66.682	788.122	411.457
P值		＜0.001	＜0.001	＜0.001
注：与心功能Ⅳ级比较，^aP＜0.05。

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表 4 血清Cys-C、β2MG、SCr单独及联合检测对CRF并发心力衰竭的诊断价值

Table 4. Diagnostic value of serum Cys-C, β2MG and SCr alone and in combination

项目	AUC	95% CI	标准误	P值	cut-off值	约登指数	灵敏度(%)	特异度(%)
Cys-C	0.797^a	0.726~0.856	0.036	＜0.001	≤1.812 mg/L	0.538	80.00	73.75
β2MG	0.828^a	0.761~0.883	0.032	＜0.001	≤2 066.421 μg/L	0.525	72.50	80.00
SCr	0.701^a	0.624~0.771	0.041	＜0.001	≤99.352 μmol/L	0.350	67.50	67.50
联合检测	0.933	0.883~0.967	0.019	＜0.001		0.750	90.00	85.00
注：与联合检测比较，^aP＜0.05。

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表 5 影响CRF并发心力衰竭患者心功能分级的logistic回归分析

Table 5. Relationship between serum Cys-C, β2MG, SCr and NYHA classification Logistic regression analysis of factors affecting cardiac function classification in CRF patients complicated with heart failure

变量	B	SE	Waldχ²	P值	OR值	95% CI
Cys-C	3.912	1.677	5.442	＜0.001	4.799	1.292~17.830
β2MG	2.025	0.655	9.564	＜0.001	7.582	1.655~9.558
SCr	2.552	1.234	4.280	＜0.001	3.938	1.174~13.204
注：将CRF并发心力衰竭作为因变量，有=1，无=0。Cys-C、β2MG、SCr为连续变量，均以实际值赋值。

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