血清胱抑素C与颈动脉粥样硬化相关性研究

The Relationship between Serum Cystatin C and Carotid Atherosclerosis

摘要: 目的：探讨缺血性脑血管病(Ischemic cerebrovascular disease, ICD)患者血清胱抑素C (Cystatin C, CysC)与颈动脉斑块性质及颈动脉狭窄程度的关系。方法：选取完善头颈部CT血管造影(CTA)的ICD患者128例，采用全自动生化分析仪测定其CysC水平。根据研究对象的血清CysC中位数水平将研究对象分为低CysC组(n = 66，CysC浓度≤0.95 mg/L)和高CysC组(n = 62，CysC浓度>0.95 mg/L)，然后比较两组患者的颈动脉斑块性质和颈动脉狭窄程度。使用Spearman等级相关分析血清CysC水平与ICD患者颈动脉斑块性质和颈动脉狭窄程度的相关性。结果：高CysC组钙化斑块的比例较低CysC组低(χ² = 18.636, P < 0.05)，混合性斑块和脂质斑块的比例均高于低CysC组(χ² = 7.326, P< 0.05; χ² = 11.291, P < 0.05)，差异均具有统计学意义；高CysC组和低CysC组斑块总比例差异无统计学意义(χ² = 3.185, P > 0.05)。高CysC组轻度狭窄比例较低CysC组低(χ² = 20.243, P < 0.05)，中度、重度或闭塞比例均高于低CysC组(χ² = 7.212, P < 0.05; χ² = 7.819, P < 0.05)，差异均具有统计学意义；高CysC组和低CysC组颈动脉狭窄总比例差异无统计学意义(χ² = 1.671, P > 0.05)。Spearman等级相关分析显示，ICD患者颈动脉斑块稳定程度、颈动脉狭窄程度均与血清CysC呈正相关(r = 0.450, P < 0.05; r = 0.376, P < 0.05)。结论：ICD患者颈动脉斑块性质、颈动脉狭窄程度与血清CysC水平相关。高CysC水平会增加不稳定斑块发生率，加重颈动脉狭窄程度。

Abstract: Objective: To investigate the relationship between serum cystatin C (CysC) and the property of carotid plaque and the degree of carotid stenosis in patients with ischemic cerebrovascular disease (ICD). Methods: 128 patients with ICD who had completed CT angiography (CTA) of head and neck were selected and their CysC levels were measured by automatic biochemical analyzer. The subjects were divided into low CysC group (n = 66, CysC concentration ≤ 0.95 mg/L) and high CysC group (n = 62, CysC concentration > 0.95 mg/L) according to the median level of serum CysC of the subjects. Then the property of carotid plaque and the degree of carotid stenosis were compared between the two groups. Spearman grade correlation was used to analyze the correlation between serum CysC level and carotid stenosis and plaque property in ICD patients. Results: The proportion of calcified plaque in high CysC group was lower than that in low CysC group (χ² = 18.636, P < 0.05); the proportion of mixed plaque and lipid plaque was higher than that in low CysC group (χ² = 7.326, P < 0.05; χ² = 11.291, P < 0.05), the difference was statistically significant. There was no significant difference in the total proportion of plaque between high CysC group and low CysC group (χ² = 3.185, P > 0.05). The proportion of mild stenosis in high CysC group was lower than that in low CysC group (χ² = 20.243, P< 0.05), and the proportion of moderate, severe or occlusion was higher than that in low CysC group (χ² = 7.212, P < 0.05; χ² = 7.819, P< 0.05), and the difference was statistically significant. The total proportion of carotid stenosis in high CysC group and low CysC group was not statistically significant (χ² = 1.671, P > 0.05). Spearman grade correlation analysis showed that the degree of carotid plaque stability and carotid stenosis in ICD patients were positively correlated with serum CysC (r = 0.450, P < 0.05; r = 0.376, P < 0.05). Conclusion: The properties of carotid plaque and the degree of carotid stenosis were correlated with the level of serum CysC in ICD patients. High CysC level will increase the incidence of unstable plaque and aggravate the degree of carotid stenosis.