摘要
目的 探讨入院时胱抑素C水平是否增强GRACE风险评分对急性冠状动脉综合征（ACS）患者12个月心血管事件的预测价值.方法 回顾性分析我院2011年6月至2012年6月400例ACS患者入院时的胱抑素C水平和GRACE风险评分.通过绘制受试者工作特征曲线（ROC）,分析胱抑素C对心血管事件的预测价值和最佳界值,并根据Logistic回归分析中的OR值,确定胱抑素C在评分中的分值,建立胱抑素C改良的GRACE风险评分.通过计算ROC曲线下面积（AUC）比较胱抑素C改良的GRACE风险评分和常规的GRACE风险评分对心血管事件的预测价值.结果 ACS患者12个月内的心血管事件发生率为33.5％.胱抑素C水平对12个月内的心血管事件有良好的预测价值（AUC：0.706,95％ CI：0.631～0.780,P=0.000）,而且在Logistic回归分析中经GRACE风险评分校正后仍保留其预测价值.GRACE风险评分预测12个月心血管事件的AUC为0.623（95％ CI：0.545～0.701）,增加胱抑素C参数后,增强了GRACE风险评分对12个月心血管事件的预测价值（AUC0.721,95％ CI：0.650 ～0.792）,差异有统计学意义（Z=2,P=0.03）.结论 入院时胱抑素C水平可以增强GRACE风险评分对ACS患者12个月心血管事件的预测价值.
Objective To explore whether admission Cystatin C could add relevant prognostic value of GRACE-risk score in cardiovascular events in patients with acute coronary syndrome （ACS）.Methods A total of 400 hospitalized ACS patients with complete clinic information from January 2011 to June 2012 were enrolled and their GRACE-risk score and cystatin C levels were analyzed.The ROC curve was used to evaluate prognostic value of Cystatin C in cardiovascular events and to propose the cut-off value of cystatin C levels.The score of cystatin C in GRACE-risk score was determined by OR based on Logistic regression analysis.Then an admission Cystatin C modified GRACE-risk score was created.The accuracy of this new score was compared with the usual GRACE-risk score by comparing the AUC of the 2 scores.Results The incidence of cardiovascular events was 33.5% within 12 months.A significant predictive value of Cystatin C for cardiovascular events within 12 months was indicated by AUC （AUC：0.706,95% CI：0.631-0.780,P =0.000）.In the Logistic regression analysis,Cystatin C remained a significant predictor of the cardiovascular events after adjustment by GRACE-risk score.The AUC for the GRACE-risk score was 0.623 （95% CI：0.545-）.701）.The addition of Cystatin C to the GRACE-risk score improved its prognostic value （AUC：0.721,95% CI：0.650-0.792）,there was significant difference between the new score and the usual GRACE-risk score （Z =2,P =0.03）.Conclusions Cystatin C adds prognostic value of the GRACE-risk score in cardiovascular events in patients with ACS.
出处
《中国心血管杂志》
2013年第6期445-448,共4页
Chinese Journal of Cardiovascular Medicine
