| BackgroundChronic heart failure (CHF) is a disease process of deterioration, and it is also the end stage of the development of a cardiovascular disease. The population aging and the increase of coronary heart disease,hypertension and other risk factors, become the main factor of senile heart failure incidence and mortality of growth, its clinical sudden death rate is 5 times as much as the normal population. To alleviate the symptoms, the patients with heart failure will be given hospital treatment frequently, and the prognosis is very poor. In a recent survey from the UK,the sample of 85 years of age and older, the presence of left ventricular systolic dysfunction and ejection fraction decreased accounted for 32%. Old people often have a variety of diseases coexist, influence each other, causing the disease symptom complex and diversity, in senile heart failure, two or more than two kinds of heart disease coexist detection rate was up to 65%, so the senile chronic heart failure is often the result of comprehensive factors. The early symptoms of senile heart failure are not typical, lead to misdiagnosis and missed diagnosis easily, make an illness aggravating, once the disease deteriorate, progress rapidly, poses a serious threat to the lives of patients. China is getting towards the aging society, the risk identification in occurrence and the progression of variable with heart failure in the elderly will be vital importance.Cystatin C (CysC) expression in human tissues is stable, and its detection have high sensitivity. As the evaluation index of glomerular filtration rate, it is also closely related to risk stratification and prognosis of cardiovascular disease. For chronic heart failure, N terminal pro brain natriuretic peptide (NT-proBNP) in the diagnosis of value has been affirmed, and increase NT-proBNP level, advantage is that the degree of heart failure, but the lack of significance in the early. In the early days of Senile patients with heart failure, renal function of the patients with only showed glomerular filtration function injury, and concentrate and reabsorption function of renal tubule keeps normal. Cystatin C as an index can effectively reflect the changes of glomerular filtration membrane permeability of early changes, and it plays an important role in the early diagnosis of mild renal damage, so the relationship between cystatin C and the Senile chronic heart failure is worthy of study and discussion.ObjectiveThrough the determination of the elderly patients with chronic heart failure of serum cystatin C level, analyze the relationship between it and different classification of cardiac function and determine the role in the diagnosis of heart failure; Judging the best boundary value of cystatin C to be used in clinical diagnosis of senile patients with chronic heart failure; and through the follow-up study, explore the role and significance for clinical prognosis.Methods93 cases of elderly (age ≥ 80 years) patients with heart failure as CHF group, male 52 cases, female 41 cases, age 80～99 years old, the average (84.68±4.01) years old. All patients from cadre health department and department of cardiology of Qilu Hospital of Shandong University in 2013 January to 2014 April, and all patients of senile heart failure meets the standard of Framingham, underlying diseases mainly for 62 cases of coronary heart disease,23 cases of hypertensive heart disease,8 cases of valvular heart disease, according to the New York Heart Association heart function classification standard (NYHA) divided into Ⅱ, Ⅲ, Ⅳ,31 cases in grade Ⅱ,32 cases in grade Ⅲ,30 cases in grade IV. Select the same time in outpatient department of cadre health department and cardiology, there is not the history of heart failure and symptoms of elderly 44 cases as control group, including male 24 cases, female 20 cases, age 80～95 years old, the average age of (83.66±3.52) years old. All the selected elderly were respectively measured CysC, NT-proBNP, blood glucose (GLU), triglyceride (TG), total cholesterol (TC) and other indicators, then the correlation analysis was performed, and using Youden index to find out the best diagnosis boundary, through the follow-up study for a period of six months, using statistical analysis with the level of cystatin C to the patients of hospitalization once again and death, then judging the value in prognosis.Results1.CysC, NT-proBNP, left ventricular end diastolic diameter (LVEDd), creatinine (Cr), blood urea nitrogen (BUN), uric acid (UA) of CHF group was statistically significant higher than the control group (P<0.01); and the left ventricular ejection fraction (LVEF) was significantly lower than the control group (P<0.01).2. With the increased cardiac function classification, CysC and NT-proBNP levels also increased, LVEF decreased, and the comparison among any two groups in different classification of cardiac function was statistically significant difference (P< 0.01).3.Correlation analysis showed that, NT-proBNP was positively correlated with age, CysC, LVEDd, Cr, BUN, UA (r=0.181,0.653,0.437,0.463,0.287 and 0.142, P<0.001), and negatively correlated with the LVEF (r=-0.636, P<0.001). CysC was positively correlated with NT-proBNP, age, LVEDd, Cr, BUN, UA (r=0.653,0.298, 0.478,0.508,0.410 and 0.231,P<0.001),and negatively correlated with LVEF (r=-0.757, P<0.001). The interference factors were adjusted, the correlation still exists,and the partial correlation coefficients were 0.548 and -0.694, P<0.001.4.The area under the ROC curve of CysC diagnosis the senile heart failure was 0.921(95% confidence interval:0.875-0.968) (P<0.001). When Cystatin C in 1.145mg/L,Youden index was the biggest, the diagnostic sensitivity was 83.9%, specificity was 93.2%. When NT-proBNP in 300.8pg/ml,Youden index was the biggest, the corresponding sensitivity was 82.8%, specificity was 95.1%.5.Through the follow-up study for six months found that, CysC level of hospitalization treatment once again due to cardiac causes was (1.46±0.29)mg/L, but CysC level of not hospitalization once again was (1.29±0.26) mg/L, there was significant difference between two groups (P<0.05); CysC level of death group in patients was (1.68±0.36)mg/L, CysC level of survival group was (1.31±0.24)mg/L, there was significant statistical difference (P< 0.01).6. Logistic regression analysis found that, CysC and NT-proBNP were the risk factors to influence death of the senile patients with heart failure, and the prediction of CysC slightly higher than NT-proBNP.Conclusions1.cystatin C levels of the senile patients with chronic heart failure significantly higher than those without heart failure of elderly people, and increased with the heart function classification increase, cystatin C was significant correlation with cardiac function index, and the interference factors were adjusted, the correlation still exists, so it has the important significance in diagnosis of senile patients with chronic heart failure.2. The best boundary value of cystatin C to be used in clinical diagnosis of senile patients with chronic heart failure is 1.145 mg/L, and the diagnostic sensitivity and specificity can be complementary with NT-proBNP, if we can joint detection the two index will compensate for the shortage of single index in the diagnosis.3.Cystatin C is one of the risk factors of death which affect the elderly patients with heart failure. As the concentration of Cystatin C is higher, the risk of hospitalization again and death is greater. |
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