胱抑素C与多发性肌炎和(或)皮肌炎患者左室舒张功能相关性及应用评价
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摘要
目的分析胱抑素C与多发性肌炎(PM)和(或)皮肌炎(DM)患者左室舒张功能不全的关系,并评价其临床应用价值。方法收治126例PM和(或)DM患者,免疫比浊法测定血清胱抑素C水平,心脏彩色多普勒超声评价左心功能,通过logistic回归分析胱抑素C与患者左室舒张功能间的关系,ROC曲线评价胱抑素C对左室舒张功能不全的诊断价值。结果相对于PM和(或)DM左室舒张功能正常者,并发左室舒张功能不全者年龄偏大、胱抑素C水平升高(P<0.01),抗Jo-1抗体阳性率低(P<0.01)。Logistic回归发现胱抑素C与左室舒张功能不全密切相关(P<0.05),ROC曲线显示胱抑素C的曲线下面积0.703,诊断PM和(或)DM左室舒张功能不全的灵敏度67%,特异度68%,准确度67%。结论胱抑素C与PM和(或)DM患者左室舒张功能不全相关,胱抑素C水平越高,左室舒张功能不全发生可能性越大,具有一定的诊断价值。
AIM To analyze the relationship between cystatin C and left ventricular diastolic dysfunction in patients with polymyositis(PM) and/or dermatomyositis(DM), and to evaluate its clinical value. METHODS 126 patients with PM and/or DM were included. Serum cystatin C levels were measured by immunoturbidimetry. Left heart function was evaluated by color Doppler echocardiography. The relationship. between cystatin C and left heart function was analyzed by logistic regression. A ROC curve was used to evaluate the diagnostic value of cystatin C levels for left ventricular dysfunction. RESULTS Compared with those with normal left ventricular diastolic function in PM and/or DM, those with left ventricular diastolic dysfunction were older, cystatin C levels were higher(P<0.01), and the positive rate of anti Jo-1 antibody was lower(P<0.01). Logistic regression further revealed that cystatin C is closely related to left ventricular diastolic dysfunction(P<0.05). The ROC curve showed that the area under the curve of cystatin C was 0.703, the sensitivity, specificity, and accuracy of diagnosis of left ventricular diastolic dysfunction in PM and/or DM were 67%, 68%, and 67%, respectively. CONCLUSION Cystatin C is associated with left ventricular diastolic dysfunction in PM and/or DM patients. The higher the levels of cystatin C, the greater the possibility of left ventricular diastolic dysfunction, which has certain diagnostic value.
AIM To analyze the relationship between cystatin C and left ventricular diastolic dysfunction in patients with polymyositis(PM) and/or dermatomyositis(DM), and to evaluate its clinical value. METHODS 126 patients with PM and/or DM were included. Serum cystatin C levels were measured by immunoturbidimetry. Left heart function was evaluated by color Doppler echocardiography. The relationship. between cystatin C and left heart function was analyzed by logistic regression. A ROC curve was used to evaluate the diagnostic value of cystatin C levels for left ventricular dysfunction. RESULTS Compared with those with normal left ventricular diastolic function in PM and/or DM, those with left ventricular diastolic dysfunction were older, cystatin C levels were higher(P<0.01), and the positive rate of anti Jo-1 antibody was lower(P<0.01). Logistic regression further revealed that cystatin C is closely related to left ventricular diastolic dysfunction(P<0.05). The ROC curve showed that the area under the curve of cystatin C was 0.703, the sensitivity, specificity, and accuracy of diagnosis of left ventricular diastolic dysfunction in PM and/or DM were 67%, 68%, and 67%, respectively. CONCLUSION Cystatin C is associated with left ventricular diastolic dysfunction in PM and/or DM patients. The higher the levels of cystatin C, the greater the possibility of left ventricular diastolic dysfunction, which has certain diagnostic value.
引文
[1] Dalakas MC.Inflammatory muscle diseases[J].N Engl J Med,2015,372(18):1734-1747.
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[8] Chew C,emberton PW,Husain AA,et al.Serum cystatin C is independently associated with renal impairment and high sensitivity C-reactive protein in systemic lupus erythematosus[J].Clin Exp Rheumatol,2013,31(2):251-255.
[9] Bi M,Huang Z,Li P,et al.The association between elevated cystatin C levels with myocardial infarction:a meta-analysis[J].Int J Clin Exp Med,2015,8(11):20540-20547.
[10]van der Laan SW,Fall T,Soumaré A,et al.Cystatin C and Cardiovascular Disease:A Mendelian Randomization Study[J].J Am Coll Cardiol,2016,68(9):934-945.
[11]Bielecka-Dabrowa A,Sakowicz A,Pietrucha T,et al.The profile of selected single nucleotide polymorphisms in patients with hypertension and heart failure with preserved and mid-range ejection fraction[J].Sci Rep,2017,7(1):8974.
[12]de Boer RA,Nayor M,deFilippi CR,et al.Association of Cardiovascular Biomarkers With Incident Heart Failure With Preserved and Reduced Ejection Fraction[J].JAMA Cardiol,2018,3(3):215-224.
[13]Akkus O,Bozkurt A,Arslantas D,et al.Is cystatin C an evaluative marker for right heart functions in systemic sclerosis?[J].Int J Cardiol,2016,221(15):478-483.
[14]Bohan A,Peter JB.Polymyositis and dermatomyositis[J].N Engl J Med,1975,292(7):44-47.
[15]Diederichsen LP,Simonsen JA,Diederichsen AC,et al.Cardiac Abnormalities in Adult Patients With Polymyositis or Dermatomyositis as Assessed by Noninvasive Modalities [J].Arthritis Care Res(Hoboken),2016,68(7):1012-1020.
[16]Barka T,van der Noen H.Expression of the cysteine proteinase inhibitor cystatin C gene in rat heart:use of digoxigenin-labeled probes generated by polymerase chain reaction directly for in situ and northern blot hybridizations[J].J Histochem Cytochem,1993,41(12):1863-1867.
[17]Sato H,Kuroda T,Tanabe N,et al.Cystatin C is a sensitive marker for detecting a reduced glomerular filtration rate when assessing chronic kidney disease in patients with rheumatoid arthritis and secondary amyloidosis[J].Scand J Rheumatol,2010,39(1):33-37.
[18]Garcia-Garcia P,Castejon R,Tutor-Ureta P,et al.Serum cystatin C is associated with kidney function but not with cardiovascular risk factors or subclinical atherosclerosis in patients with Systemic Lupus Erythematosus[J].Clin Rheumatol,2017,36(12):2709-2717.
[19]Shlipak MG,Katz R,Fried LF,et al.Cystatin C and mortality in elderly person with heart failure[J].Am Coll Cardiol,2005,45(2):268-271.
[20]Svensson-F?rbom P,Ohlson Andersson M,Almgren P,et al.Cystatin C identifies cardiovascular risk better than creatinine-based estimates of glomerular filtration in middle-aged individuals without a history of cardiovascular disease[J].J Intern Med,2014,275(5):506-521.
[21]Breidthardt T,Sabti Z,Ziller R,et al.Diagnostic and prognostic value of cystatin C in acute heart failure[J].Clin Biochem,2017,50(18):1007-1013.
[22]Schanz M,Pannes D,Dippon J,et al.The influence of thyroid function,inflammation,and obesity on risk prediction of acute kidney injury by cystatin c in the emergency department[J].Kidney Blood Press Res,2016,41(5):604-613.
[23]Aggarwa R,Cassidy E,Fertig N,et al.Patients with non-Jo-1 anti-tRNA-synthetase autoantibodies have worse survival than Jo-1 positive patients[J].Ann Rheum Dis,2014,73(1):227-232.
[2] 袁云.特发性炎性肌病进展[J].中国现代神经疾病杂志,2016,10(16):647-650.
[3] Schwartz T,Diederichsen LP,Lundberg IE,et al.Cardiac involvement in adult and juvenile idiopathic inflammatory myopathies[J].RMD Open,2016,2(2):e000291.
[4] Wang H,Liu HX,Wang YL,et al.Left ventricular diastolic dysfunction in patients with dermatomyositis without clinically evident cardiovascular disease[J].J Rheumatol,2014,41(3):495-500.
[5] Shah SJ,Heitner JF,Sweitzer NK,et al.Baseline characteristics of patients in the treatment of preserved cardiac function heart failure with an aldosterone antagonist trial[J].Circ Heart Fail,2013,6(2):184-192.
[6] Oktay AA,Shah SJ.Diagnosis and Management of Heart Failure with Preserved Ejection Frac-tion:10 Key Lessons[J].Curr Cardiol Rev,2015,11(1):42-52.
[7] Peixoto L,Aguiar P,de Bragana R,et al.Cystatin C:A Promising Marker of Renal Function in Patients with Systemic Lupus Erythematosus?[J].Acta Med Port,2015,28(3):333-341.
[8] Chew C,emberton PW,Husain AA,et al.Serum cystatin C is independently associated with renal impairment and high sensitivity C-reactive protein in systemic lupus erythematosus[J].Clin Exp Rheumatol,2013,31(2):251-255.
[9] Bi M,Huang Z,Li P,et al.The association between elevated cystatin C levels with myocardial infarction:a meta-analysis[J].Int J Clin Exp Med,2015,8(11):20540-20547.
[10]van der Laan SW,Fall T,Soumaré A,et al.Cystatin C and Cardiovascular Disease:A Mendelian Randomization Study[J].J Am Coll Cardiol,2016,68(9):934-945.
[11]Bielecka-Dabrowa A,Sakowicz A,Pietrucha T,et al.The profile of selected single nucleotide polymorphisms in patients with hypertension and heart failure with preserved and mid-range ejection fraction[J].Sci Rep,2017,7(1):8974.
[12]de Boer RA,Nayor M,deFilippi CR,et al.Association of Cardiovascular Biomarkers With Incident Heart Failure With Preserved and Reduced Ejection Fraction[J].JAMA Cardiol,2018,3(3):215-224.
[13]Akkus O,Bozkurt A,Arslantas D,et al.Is cystatin C an evaluative marker for right heart functions in systemic sclerosis?[J].Int J Cardiol,2016,221(15):478-483.
[14]Bohan A,Peter JB.Polymyositis and dermatomyositis[J].N Engl J Med,1975,292(7):44-47.
[15]Diederichsen LP,Simonsen JA,Diederichsen AC,et al.Cardiac Abnormalities in Adult Patients With Polymyositis or Dermatomyositis as Assessed by Noninvasive Modalities [J].Arthritis Care Res(Hoboken),2016,68(7):1012-1020.
[16]Barka T,van der Noen H.Expression of the cysteine proteinase inhibitor cystatin C gene in rat heart:use of digoxigenin-labeled probes generated by polymerase chain reaction directly for in situ and northern blot hybridizations[J].J Histochem Cytochem,1993,41(12):1863-1867.
[17]Sato H,Kuroda T,Tanabe N,et al.Cystatin C is a sensitive marker for detecting a reduced glomerular filtration rate when assessing chronic kidney disease in patients with rheumatoid arthritis and secondary amyloidosis[J].Scand J Rheumatol,2010,39(1):33-37.
[18]Garcia-Garcia P,Castejon R,Tutor-Ureta P,et al.Serum cystatin C is associated with kidney function but not with cardiovascular risk factors or subclinical atherosclerosis in patients with Systemic Lupus Erythematosus[J].Clin Rheumatol,2017,36(12):2709-2717.
[19]Shlipak MG,Katz R,Fried LF,et al.Cystatin C and mortality in elderly person with heart failure[J].Am Coll Cardiol,2005,45(2):268-271.
[20]Svensson-F?rbom P,Ohlson Andersson M,Almgren P,et al.Cystatin C identifies cardiovascular risk better than creatinine-based estimates of glomerular filtration in middle-aged individuals without a history of cardiovascular disease[J].J Intern Med,2014,275(5):506-521.
[21]Breidthardt T,Sabti Z,Ziller R,et al.Diagnostic and prognostic value of cystatin C in acute heart failure[J].Clin Biochem,2017,50(18):1007-1013.
[22]Schanz M,Pannes D,Dippon J,et al.The influence of thyroid function,inflammation,and obesity on risk prediction of acute kidney injury by cystatin c in the emergency department[J].Kidney Blood Press Res,2016,41(5):604-613.
[23]Aggarwa R,Cassidy E,Fertig N,et al.Patients with non-Jo-1 anti-tRNA-synthetase autoantibodies have worse survival than Jo-1 positive patients[J].Ann Rheum Dis,2014,73(1):227-232.
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