实验探讨老年冠心病患者血清中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和胱抑素C（Cys-C）水平与心肾功能关系及其对早期肾损害的诊断价值。
Toexploretherelationshipamongserumneutrophilgelatinaseassociatedlipocalin（NGAL）,cystatinC（Cys-C）levelsandcardiac,renalfunction;anddiagnosticvalueofNGALandCys-Cforearlyrenaldamageinagedpatientswithcoronaryheartdisease（CHD）.选择84例老年冠心病患者，NYHA心功能Ⅰ~Ⅳ级（Ⅰ级组30例、II级组28例、Ⅲ~Ⅳ级组26例），另选择31例老年健康者为健康对照组。测定患者血清N末端B型利钠肽原（NT-proBNP）、NGAL和Cys-C等指标，并分析血清NGAL和Cys-C水平与NT-proBNP和估计肾小球滤过率（eGFR）的相关性。应用受试者操作工作特征（ROC）曲线评价血清NGAL和Cys-C诊断肾功能不全的准确性。
AccordingtoNYHAcardiacfunctionclassification,atotalof84agedCHDpatientsweredividedintoclassIgroup（n=30）,classⅡgroup（n=28）andclassⅢ-Ⅳgroup（n=26）.Another31agedhealthyobjectswereselectedashealthycontrolgroup.SerumNterminalproB-typenatriureticpeptide（NT-proBNP）,NGALandCys-Cetc.levelsweremeasured,andthecorrelationamongserumNGAL,Cys-Clevelsandcardiacfunction,estimatedglomerularfiltrationrate（eGFR）wereanalyzed.TheaccuracyofserumNGALandCys-Cdiagnosingrenalinsufficiencywasevaluatedbyreceiveroperatorcharacteristiccurve（ROC）.健康对照组，NYHAⅠ、II、Ⅲ~Ⅳ级组血清NGAL［（36.96±21.23）μg/L比（87.80±61.40）μg/L比（.21±92.96）μg/L比（.15±98.46）μg/L］和Cys-C［（0.75±0.64）mg/L比（1.40±1.88）mg/L比（2.33±2.03）mg/L比（3.45±1.81）mg/L］水平随着心衰程度加重而升高，以NYHAⅢ~Ⅳ级组升高最为明显，4组血清NGAL水平两两比较均有显著性差异（P0.01），而血清Cys-C水平除在NYHAI级组与健康对照组比较无显著性差异（P0.05）外，其余各组两两比较差异均有统计学意义（P0.05或0.01）。Pearson相关分析显示血清NGAL和Cys-C水平与NT-proBNP均呈正相关（r值分别为0.和0.，P均0.01），与eGFR均呈负相关（r值分别为-0.和-0.，P均0.01），且血清NGAL水平与NT-proBNP和eGFR的相关性更密切。血清NGAL和Cys-C诊断肾功能不全的ROC曲线下面积分别为0.和0.。
AlongwithNYHAclassincreased,thereweresignificantincreaseinserumlevelsofNGAL［（36.96±21.23）μg/Lvs.（87.80±61.40）μg/Lvs.（.21±92.96）μg/Lvs.（.15±98.46）μg/L］andCys-C［（0.75±0.64）mg/Lvs.（1.40±1.88）mg/Lvs.（2.33±2.03）mg/Lvs.（3.45±1.81）mg/L］inhealthycontrolgroup,NYHAI,Ⅱ,Ⅲ-Ⅳgroups,andtheywerehighestinNYHAclassⅢ-Ⅳgroup,therewassignificantdifferenceinserumNGALlevelbetweenanytwogroupsamongthefourgroups（P0.01）,andsowasserumCys-Clevel（P0.05or0.01）excepthealthycontrolgroupandNYHAclassIgroup（P0.05）.PearsoncorrelationanalysisindicatedthatserumNGALandCys-ClevelswerepositivelycorrelatedwithNT-proBNP（r=0.,0.,P0.01both）,andnegativelycorrelatedwitheGFR（r=-0.,-0.,P0.01both）,andserumNGALlevelhadclosercorrelationwithNT-proBNPandeGFR.AreaunderROCofserumNGALandCys-Cwere0.and0.respectivelyindiagnosingrenalinsufficiency.结果发现老年冠心病慢性心力衰竭患者血清NGAL和Cys-C水平与心肾功能有较好的相关性，是诊断早期肾损害敏感而准确的指标。
SerumNGALandCys-ClevelshavegoodcorrelationwithcardiacandrenalfunctioninagedCHDpatients,whicharesensitiveandaccurateindexesfordiagnosingearlyrenaldamage.作者：朱红，*娜，杨伟等
单位：医院综合科
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