The Clinical Value Of Serum Cys-C,H-FABP And NAG In Elderly With Type 2 Cardiorenal Syndrome

Objective:To explore the diagnostic value of serum cystatin C(Cys-C),heart type fatty acid binding protein(H-FABP)and N-acetyl-?-D-glucosaminidase(NAG)in the elderly with type 2 cardiorenal syndrome(CRS),and to investigate their correlation with cardiac and renal function.Methods:1. We studied 97 elderly patients(age?65 years old)with chronic heart failure(CHF)in Cardiovascular Department of Hebei General Hospital from October 2018 to May 2019.According to an estimated glomerular filtration rate(e GFR)cut-off of 60 ml/min/1.73 m~2,patients were assigned to the CRS group or the CHF group.Exclusion criteria:patients with primary nephropathy,CHF caused by chronic renal failure,malignant tumor,autoimmune diseases,and rheumatic valvular heart disease.2.We recorded the subjects'basic information,including name,age(years),gender,heart rate,systolic and diastolic pressure,fasting blood glucose,body mass index,alamine aminotransferase,aspartate aminotransferase,NYHA classification grading of cardiac function,and whether they had hypertension,diabetes,dislipidemia,hypothyroidism,inflammation,or urinary protein.And we measured and compared the results of estimation of glomerular filtration(e GFR),Cys-C,H-FABP,NAG in fasting blood of both groups,in order to acknowledge the differences and the correlation between CRS and CHF.3.Data were analyzed using SPSS version 23.0(IBM Corp,NY).Normal distribution data were expressed by mean±standard deviation(X±SD).Non-normal distribution data were expressed by the median and interquartile range method[M(QR)],and were performed using the Mann-Whitney U(MWU)rank sum test.Enumeration data were expressed in percentage(%),and were performed using chi-square test.The correlations between indicators were analyzed using Spearman rank correlation analysis.We calculated the area under the receiver operating characteristic curve(ROC)of serum Cys-C,H-FABP and NAG to evaluate the diagnostic efficacy on type 2 CRS.P<0.05was regarded as statistically significant.Result:According to the e GFR,49 patients(50.5%)were assigned to CRS group and 48 patients(49.5%)to CHF group,of which 44 were male(45.4%)and 53were female(54.6%).The general indexes(age,gender,heart rate,systolic and diastolic pressure,fasting blood glucose,body mass index,alamine aminotransferase,aspartate aminotransferase,urine protein,hypertension,diabetes,dislipidemia,hypothyroidism and inflammation)between the two groups had no significant difference(P>0.05).1. We used the MWU rank sum test to analysis the levels of serum biomarkers in two groups.Cys-C and H-FABP in CRS group were significantly higher than those in CHF group(P<0.05),but not NAG.2. We used the Spearman rank correlation analysis to calculate the levels of serum biomarkers in two groups.Cys-C was positively correlated with NYHA cardiac function grading(r=0.292,P=0.004)but negatively correlated with renal function(r=-0.691,P<0.001),H-FABP was negatively correlated with renal function(r=-0.281,P=0.005).3. The area under the ROC curve of Cys-C was[0.851,95%CI(0.774,0.928)],the sensitivity was 81.6%,the specificity was 77.1%,the Jordan index was 58.7%,the positive predictive value was 78.1%,and the negative predictive value was 80.7%.The area under the ROC curve of H-FABP was[0.656,95%CI(0.545,0.767)],the sensitivity was 83.7%,the specificity was52.1%,the Jordan index was 35.8%,the positive predictive value was 63.6%,and the negative predictive value was 76.2%.Conclusion:1.Serum Cys-C and H-FABP are elevated in elderly with type 2 CRS and might be used in the diagnosis and differential diagnosis of elderly with type 2CRS.2.Cys-C is positively correlated with NYHA cardiac function but negatively correlated with renal function,while H-FABP is positively correlated with renal function staging.3. Cys-C has a medium predictive value for the incidence of elderly withtype 2 CRS,H-FABP has a low predictive value,and NAG has no predictive value.