Cystatin C and subclinical brain infarction
Cystatin C and subclinical brain infarction
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DOI：
10.1681/asn.2005010006
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发表时间：
2005-12-01
影响因子：
13.6
通讯作者：
Siscovick, DS
中科院分区：
文献类型：
--
作者：
Seliger, SL;Longstreth, WT;Siscovick, DS
亚临床脑梗塞(SBI)在老年人中很常见，并与隐匿性神经和认知障碍有关。虽然肾功能损害与加速的脑血管疾病和增加临床明显脑梗塞的风险有关，但很少有研究探讨肾功能和SBI之间的关系，这些研究可能受到肌酐作为肾功能标记物的不准确性的限制。在心血管健康研究中，对老年人进行了一项横断面研究，以检查SBI与肾功能的两个血清标志物：血清肌酐(Scr)和胱抑素C(CysC)的相关性。1992年至1993年，患者接受了头颅磁共振成像和肾脏标记物的测量。Logistic回归用于估计肾功能(由1/Scr和1/CysC估计)和SBI之间的关系，控制潜在的混杂因素。在2784名参与者中，有789人(28.7%)出现了SBI。1/CysC(Per 1-SD减少量；优势比[OR]1.2；95%可信区间[CI]1.09至1.32；P<；0.001)与SBI呈线性相关，但与1/Scr(OR 1.08；95%CI 0.98至1.19；P=0.14)无关，呈二次U型相关(P=0.004)。在有两个标记的模型中，1/CysC与SBI呈线性相关(OR1.26；P<；0.001)，而1/Scr不呈线性相关(OR1.06；P=0.30)。在老年人中，作为肾功能新标志物的CysC与SBI的相关性更强、更直接，而Scr与SBI的相关性呈U型，且在高、低水平患病率均较高。
Subclinical brain infarcts (SBI) are common in the elderly and are associated with covert neurologic and cognitive impairment. Although renal impairment is associated with accelerated cerebrovascular disease and an increased risk for clinically apparent brain infarct, few studies have examined the relationship between renal function and SBI, and these m ay have been limited by the inaccuracy of creatinine as a renal function marker. A cross-sectional study was performed among older adults in the Cardiovascular Health Study to examine associations between SBI and two serum markers of renal function: Serum creatinine (SCr) and cystatin C (CysC). Patients had cranial magnetic resonance imaging and renal markers measured in 1992 to 1993. Logistic regression was used to estimate the associations between renal function (estimated by 1/SCr and 1/CysC) and SBI, controlling for potential confounding factors. SBI were present in 789 (28.7%) of 2784 participants. A linear association with SBI was observed for 1/CysC (per 1-SD decrement; odds ratio [OR] 1.20; 95% confidence interval [CI] 1.09 to 1.32; P < 0.001) but not for 1/SCr (OR 1.08; 95% CI 0.98 to 1.19; P = 0.14), for which a quadratic U-shaped association was;suggested (P = 0.004). In a model with both markers, 1/CysC was linearly associated with SBI (OR 1.26; P < 0.001), whereas 1/SCr was not (OR 1.06; P = 0.3). The prevalence of SBI was directly associated with quintile of CysC, whereas the association 'between SCr and SBI was U-shaped, with greater prevalence at high and low levels. Compared with creatinine, CysC, a novel marker of renal function, has a stronger and more direct association with SBI in the elderly.