Cystatin C and mortality risk in the elderly: The health, aging, and body composition study
Cystatin C and mortality risk in the elderly: The health, aging, and body composition study
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DOI：
10.1681/asn.2005050545
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发表时间：
2006-01-01
影响因子：
13.6
通讯作者：
Fried, Linda F.
中科院分区：
文献类型：
--
作者：
Shlipak, Michael G.;Fyr, Christina L. Wassel;Fried, Linda F.
众所周知，肾功能障碍会降低老年人的预期寿命。半胱氨酸蛋白酶抑制剂C是一种新的肾功能生物标志物，可能对老年人有预后作用。在一个黑人和白色非卧床老年人的双盲队列中评估了胱抑素C与死亡率的相关性，并与血清肌酐浓度进行了比较。健康、衰老和身体组成研究是一项功能良好的老年人队列研究，旨在评估体重、身体组成和功能的纵向变化。1997年4月至1998年6月，在田纳西州孟菲斯和宾夕法尼亚州匹兹堡的研究中心共招募了3075名年龄在70岁至79岁之间的无残疾参与者，随访6年。入组时，平均胱抑素C为1.05 mg/L，平均肌酐为1.06 mg/dl。经过6年的随访，557名参与者死亡。每一个上升的半胱氨酸蛋白酶抑制剂C五分位数的死亡率分别为1.7，2.7，2.9，3.1和5.4%/年。在调整人口统计学风险因素、共病健康状况和炎症生物标志物（C反应蛋白、IL-6）后，和TNF-α），与最低水平相比，半胱氨酸蛋白酶抑制剂C的每五分位数与死亡风险增加显著相关：（HR; 95%置信区间）五分位数1，-1.0（参考）;五分位2，-1.74（1.21至2.50）;五分位3，-1.51（1.05至2.18）;五分位4，-1.49（1.04至2.13）;五分位5，-2.18（1.53至3.10）。这些关联并不因性别或种族而异。心血管和其他原因死亡率的结果是一致的，但不是癌症死亡率。多变量校正后，肌酐五分位数与死亡率无关（HR：1.0 [参考]，1.00 [0.72至1.39]，0.95 [0.68至1.32]，1.11 [0.79至1.57]，1.16 [0.86至1.58]）。半胱氨酸蛋白酶抑制剂C是老年人死亡的一个强有力的独立危险因素。未来的研究应调查胱抑素C是否在临床医学中发挥作用。
Kidney dysfunction is known to decrease life expectancy in the elderly. Cystatin C is a novel biomarker of kidney function that may have prognostic utility in older adults. The association of cystatin C with mortality was evaluated in a biracial cohort of black and white ambulatory elderly and compared with that of serum creatinine concentrations. The Health, Aging and Body Composition study is a cohort of well-functioning elderly that was designed to evaluate longitudinal changes in weight, body composition, and function. A total of 3075 participants who were aged 70 to 79 yr and had no disability were recruited at sites in Memphis, TN, and Pittsburgh, PA, between April 1997 and June 1998 with a follow-up of 6 yr. At entry, the mean cystatin C was 1.05 mg/L and the mean creatinine was 1.06 mg/dl. After 6 yr of follow-up, 557 participants had died. The mortality rates in each ascending cystatin C quintile were 1.7, 2.7, 2.9, 3.1, and 5.4%/yr. After adjustment for demographic risk factors, comorbid health conditions, and inflammatory biomarkers (C-reactive protein, IL-6. and TNF-alpha), each quintile of cystatin C was significantly associated with increased mortality risk compared with the lowest: Hazard ratios (HR; 95% confidence intervals) quintile 1, -1.0 (referent); quintile 2, -1.74 (1.21 to 2.50); quintile 3, -1.51 (1.05 to 2.18); quintile 4, -1.49 (1.04 to 2.13); and quintile 5, -2.18 (1.53 to 3.10). These associations did not differ by gender or race. Results were consistent for cardiovascular and other-cause mortality, but not cancer mortality. Creatinine quintiles were not associated with mortality after multivariate adjustment (HR: 1.0 [referent], 1.00 [0.72 to 1.39], 0.95 [0.68 to 1.32], 1.11 [0.79 to 1.57], 1.16 [0.86 to 1.58]). Cystatin C is a strong, independent risk factor for mortality in the elderly. Future studies should investigate whether cystatin C has a role in clinical medicine.