Cystatin Research Articles

Elevated expression of CST1 promotes breast cancer progression and predicts a poor prognosis

Cystatin SN (CST1) belongs to the type 2 cystatin (CST) superfamily, which restricts the proteolytic activities of cysteine proteases. CST1 has been recently considered to be involved in the development of several human cancers. However, the prognostic significance and function of CST1 in breast cancer remains unknown. In the current study, we found that CST1 was generally upregulated in breast cancer at both mRNA and protein level. Furthermore, overall survival (OS) and disease-free survival (DFS) in the low CST1 expression subgroup were significantly superior to the high CST1 expression subgroup (OS, p < 0.001; DFS, p < 0.001), which indicated that CST1 expression level was closely correlated to the survival risk of these patients. Univariate and multivariate analyses demonstrated that CST1 expression was an independent prognostic factor, the same as ER status and nodal status. Next, CST1 overexpression promoted breast cancer cell proliferation, clonogenicity, migration, and invasion abilities. By contrast, knockdown of CST1 attenuated these malignant characteristics in breast cancer cells. Collectively, our study indicates that CST1 cannot only serve as a significant prognostic indicator but also as a potential therapeutic target for breast cancer.Key messagesHigh CST1 expression is negatively correlated with survival of breast cancer patients.CST1 promotes cell proliferation, clone formation, and metastasis in breast cancer cells.CST1 is a novel potential prognostic biomarker and therapeutic target for breast cancer.

Prognostic value of pre-chemotherapy serum cystatin C in patients with castration-resistant prostate cancer

Objective To explore the prognostic value of pre-chemotherapy serum cystatin C (Cys C) in patients with castration-resistant prostate cancer (CRPC). Methods The medical records of 48 patients with CRPC were reviewed. These patients were diagnosed and underwent docetaxel-based chemotherapy in Xinjiang Military Command General Hospital between January 2009 and January 2015. Statistical analysis was performed to identify the clinical and prognosis value of Cys C. Results Of 48 patients with CRPC, the expre-ssion of serum Cys C before chemotherapy was related with Gleason score (χ2=4.218, P=0.040) and distant metastasis(χ2=4.090, P=0.043). 23 patients was in high group (Cys C>1.61 mg/L), 25 in low (Cys C≤1.61 mg/L). The median survival time of high group and low group were 15.6 and 25.3 months, respectively (χ2=13.876, P<0.001). Univariate analysis showed that TNM stage (χ2=6.934, P=0.018), Gleason score (χ2=7.933, P=0.005), baseline prostate specific antigen (PSA) (χ2=9.038, P=0.003), number of chemotherapy cycles (χ2=5.024, P=0.028), distant metastases (χ2=6.963, P=0.013) and serum Cys C before chemotherapy (χ2=6.976, P=0.012) were associated with overall survival of patients with CRPC. COX multivariate analysis showed that baseline PSA at diagnosis (χ2=4.257, P=0.039), number of chemotherapy cycles (χ2=6.245, P=0.017), distant metastases (χ2=5.122, P=0.028) and serum Cys C before chemotherapy (χ2=8.172, P=0.004) were independent risk factors of overall survival of patients with CRPC, especially serum Cys C before chemotherapy (HR=2.394). Conclusion The patients with high Cys C level have poor prognosis, and the pre-chemotherapy Cys C is an independent risk factor for prognosis of CRPC patients treated with docetaxel-based chemotherapy which can be used as an effective indicator to assess the prognosis of CRPC. Key words: Prostatic neoplasms; Prognosis; Drug therapy; Cystatin C

The diagnosis value of serum human epididymis protein 4 and CA 125 in chronic kidney disease

Objective To investigate the changes and diagnostic value of serum concentrations of human epididymis protein 4(HE4)and carbohydrate antigen 125(CA 125)in different stages of chronic kidney disease(CKD). Methods From February 2015 to August 2016, a total of 158 cases of patients with CKD were divided into the CKD group, another 150 cases of healthy physical examination were divided into the control group.The concentration of serum HE4, CA 125 were analyzed by electrochemiluminescence, and serum creatinine(Scr)was detected by ultraviolet enzymatic method, serum cysteine protease inhibitor(cystatin C, Cys-C)was measured by immunoturbidimetry, the level of serum urea(BUN)was analyzed by urea enzyme-glutamate dehydrogenase enzyme hydrolysis method, and estimated glomerular filtration rate(GFR)was calculated by CKD-EPIcreatinine.The association of serum HE4 and CA 125, GFR, Scr, BUN, Cys-C were analyzed by pearson correlation analysis in CKD patients.The efficiency of serum HE4 and CA 125, Scr, BUN and Cys-C were compared to the diagnosis value of CKD by the receiver operating characteristic curve(ROC). Results The concentration of HE4, Cys-C in CKD group increased significantly, compared with that in the control group, the difference had statistical significance(P 0.05), while in CKD5, the difference had statistical significance.In stage CKD1-CKD2 patients the serum level of Scr and BUN, compared with that in the control group, there was no statistically significant difference(P>0.05), while in stage CKD3-CKD5 patients, the difference had statistical significance(P 0.05). There was no correlation between CA 125 and GFR, Scr, BUN, Cys-C(P>0.05). The ROC curve analysis showed that the efficiency to the diagnosis of CKD was primarily the HE4(AUC=0.957), followed by the Cys-C(AUC=0.840), the last was the Scr, BUN(AUC=0.786, 0.636), while the CA 125(AUC=0.534)had no diagnostic value. Conclusion The concentration of HE4 had certain diagnostic value to CKD, and significantly increased with different stages of CKD patients.It may predict the occurrence and development of CKD. Key words: Chronic kidney disease; Human epididymis protein 4; Carbohydrate antigen 125

Clinical efficacy and safety of leflunomide combined with prednisone in the treatment of immunoglobulin A nephropathy

Objective To explore the clinical efficacy and safety of leflunomide combined with prednisone in the treatment of immunoglobulin A nephropathy. Methods 80 patients with IgA nephropathy were chosen and randomly divided into two groups, 40 cases in each group.The control group was orally given prednisone(initial dose 1mg·kg-1·d-1), after 2 months of treatment 5mg/2 weeks reduction, and 10mg/d as maintenance therapy, while the observation group was treated with 20mg/d leflunomide treatment based on the treatment of control group.All the two groups had 3 months as a course of treatment.Before treatment and after treatment, the 24h urinary protein, serum albumin, serum creatinine, glomerular filtration rate, cholesterol, triglycerides, cystatin C levels and urinary vascular cell adhesion molecule-1 after treatment (urinary VCAM-1) and interleukin-18 (IL-8) in the two groups were recorded and compared, as well as the clinical efficacy and adverse reactions. Results The total effective rate in the observation group was 92.5%, which was significantly higher than 75.0% in the control group (χ2=4.501, P 0.05). After treatment, in the observation group, the serum creatinine, cystatin C, 24h urinary protein excretion, VCAM-1 and IL-8 in urine were significantly lower than those in the control group, while serum albumin and glomerular filtration rate were significantly higher (t≥2.632, all P 0.05). In the observation group, the incidence rate of adverse reaction was 10.0%, that in the control group was 8.6%, there was no statistically significant difference between the two groups(χ2=0.157, P>0.05). Conclusion Leflunomide combined with prednisone in the treatment of IgA nephropathy has better clinical efficacy and higher safety, its mechanism may be associated with decreased urinary VCAM-1 and serum IL-18 levels. Key words: Leflunomide; Prednisone; Immunoglobulin A nephropathy; Clinical efficacy

Comparison of Effects of Low-Flow Sevoflurane and Low-Flow Desflurane Anaesthesia on Renal Functions Using Cystatin C.

Numerous studies have indicated nephrotoxic effects of sevoflurane because of its two bioproducts compound A and fluoride. Cystatin C (CyC) is a more sensitive biomarker than creatinine to show early and mild changes in kidney function. We designed this prospective randomised study to compare the effects of low-flow sevoflurane anaesthesia and low-flow desflurane anaesthesia on renal functions based on CyC levels. No studies have evaluated the effects of low-flow sevoflurane anaesthesia on renal functions based on CyC levels to date. Thirty American Society of Anesthesiologists (ASA) physical status I-II patients who were scheduled for urological procedures were enrolled in this study. The patients were randomly assigned to 2 groups: low-flow sevoflurane anaesthesia or low-flow desflurane anaesthesia. Serum urea, creatinine and CyC levels were measured before the operation, just before extubation and 24 h after the operation. Creatinine clearance was calculated in the first 24-h urine sample. There were no significant differences in serum urea, creatinine and CyC levels or 24 h creatinine clearance between the groups. Our study demonstrates with a more sensitive biomarker, CyC, that low-flow sevoflurane anaesthesia is safe in terms of the effects on renal function.

Influence of alprostadil on renal function, oxidative stress, and immune function in early diabetic nephropathy patients

Objective To investigate the influence of alprostadil on renal function, oxidative stress, and immune function in early diabetic nephropathy patients. Methods Eighty-six cases of early diabetic nephropathy patients in our hospital during April 2013 to January 2016 were chosen as research subjects, all patients were divided into observation (n=43) and control (n=43) groups according to random data form. Patients in observation group received alprostadil combined with pioglitazone treatment and those in control group received pioglitazone treatment only, both lasted for one month. Before treatment, one month after treatment, renal function indices were detected; serum oxidative stress indices were detected by automatic biochemical analyzer; T lymphocyte subsets in peripheral blood were measured by flow cytometry. Results Before treatment, there were no significant differences in renal function, oxidative stress, immune function between two groups (P>0.05). One month after treatment, peripheral blood renal function indices such as blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), and cystatin C (CysC) levels were lower in observation group than in control group, the level of serum albumin (Alb) was higher in observation group than in control group, the difference was statistically significant (P<0.05); serum oxidation indices malondialdehyde (MDA), and advanced oxidation protein products (AOPP) were lo-wer in observation group than in control group, human antioxidant indices such as superoxide dismutase (SOD), and total antioxidant capacity (T-AOC) were higher in observation group than in control group, the difference was statistically significant (P<0.05); peripheral blood CD3+ , CD4+ T lymphocytes and the ratio of CD4+ /CD8+ were higher in observation group than in control group, CD8+ T lymphocyte level was lower in observation group than in control group, the difference was statistically significant (P<0.05). Conclusions Alprostadil can optimize the renal function and immune function in early diabetic nephropathy patients, reduce the degree of oxidative stress. Key words: Alprostadil; Diabetic nephropathies; Kidney; Oxidative stress; Immunity

Function of Cystatin SN and its relationship with tumors

Cysteine protease inhibitor SN (Cystatin SN) is a secretory protein encoded by CST1, with the promotion of cell senescence and apoptosis activity, playing an important role in the regulation of proteolytic activity. Many studies have found that Cystatin SN is abnormally expressed in various kinds of tumors, and is closely related with the tumorigenesis and progression. Cystatin SN may play an important role in the diagnosis and prognosis of tumors. Key words: Cysteine proteinase inhibitors; Neoplasms; Function

The value of symmetrical ambulatory arterial stiffness index should be noted in prediction of early renal impairment in patients with essential hypertension

Objective To investigate the predictive value of symmetrical ambulatory arterial stiffness index (S-AASI) in detecting early renal impairment of patients with essential hypertension. Methods Totally 245 consecutive out-patients were confirmed with essential hypertension, and were divided into group A (56 cases), group B (64 cases), group C (72 cases), and group D (53 cases) according to the quartile of S-AASI. The combination testing of serum cystatin C, serum β2-microglobulin as well as urine microalbumin to creatinine ratio were implemented as laboratory diagnosis index of renal impairment in early stage and 109 essential hypertension patients were diagnosed with early renal impairment. The parameters were compared among 4 groups. Pearson correlation analysis and partial correlation analysis were performed to confirm the relationship between the markers of early renal impairment and S-AASI. The predictive value of S-AASI to detect early renal injury was evaluated by analyzing Receiver Operating Characteristic (ROC) curve. Results With the rising of S-AASI, age as well as 24 hours mean systolic blood pressure (24 h SBP), serum cystatin C, serum β2-microglobulin, urine microalbumin to creatinine ratio and the incidence rate of early renal injury went notably higher while estimated glomerular filtration rate (eGFR) decreased significantly. After controlling for age, correlation test showed S-AASI was positively correlated with24hSBP, serum cystatin C, serumβ2-microglobulin, urine microalbumin to creatinine ratio(r=0.392, 0.627, 0.514 and 0.643 respectively, P<0.05)and negatively correlated with eGFR(r=-0.312, P<0.05). The 24 hours mean diastolic blood pressure (24 h DBP) was uncorrelated with S-AASI. Area under ROC curve of S-AASI for diagnosis of hypertensive renal impairment was 0.885. The critical value of S-AASI was 0.17, the sensitivity, specificity, positive predictive value, and negative predictive value were 92.7%, 65.2%, 68.5%, and 91.7%, respectively. Conclusions When S-AASI was detected above 0.17, patients with hypertension had a higher risk of renal impairment. Higher S-AASI was correlated with worse early renal impairment laboratory indexes. The predictive accuracy of S-AASI for early hypertensive renal impairment was medium. Key words: Arteriosclerosis; Hypertension/CO; Kidney diseases/CO; Forecasting

Evaluation of the value of early use of norepinephrine infusion in the improvement of renal function in patients with severe sepsis with early renal impairment using cystatin C, a sensitive renal marker

Introduction Acute renal failure occurs in ∼23% of patients with severe sepsis. The combination of acute renal failure and severe sepsis may carry a mortality of up to 70%. Several studies have demonstrated that serum cystatin C level is a better marker of glomerular filtration rate (GFR) compared with serum creatinine, particularly for individuals with small-to-moderate decreases in GFR. To maintain organ perfusion in sepsis, a mean arterial pressure of 65 mmHg should be maintained with fluid therapy and vasopressors. Marked delays in initiation are associated with increase in mortality risk in patients with septic shock. Patients and methods Sixty patients enrolled in the study proved to have severe sepsis with early renal impairment. Patients were randomly allocated into one of two groups (30 patients each): the norepinephrine infusion group (the N group) and the control group (the C group). The N group received norepinephrine infusion + conventional treatment for severe sepsis, whereas the C group was treated with conventional treatment for severe sepsis according to the latest Surviving Sepsis Campaign. For each patient, the following data were collected: age, body weight, hemodynamic changes, urine output, renal function as detected from levels of the sensitive renal marker cystatin C and from serum creatinine levels, blood urea nitrogen, and estimated GFR (eGFR). Results There was a statistically significant increase in blood pressure and urine output in the N group at 10 min and 2 h, respectively, after norepinephrine infusion and on comparing subsequent measures with baseline values (T0) and also when compared with corresponding values in the C group. In addition, patients in the N group showed a statistically signifi cant decrease in serum cystatin C levels and an increase in eGFR based on cystatin C levels after 2 h of norepinephrine infusion, compared with baseline values and values in the C group, denoting marked improvement in GFR. Serum creatinine levels, blood urea nitrogen levels, and eGFR based on serum creatinine levels showed no significant difference in either group whether compared with baseline of the same group or when comparing both groups together. Conclusion The results this study demonstrate that early continuous infusion of norepinephrine at 0.5–1 μg/ kg/min may have a renoprotective role in septic patients with early renal impairment detected by levels of the sensitive renal marker cystatin C.

The research progress of equations for estimated glomerular filtration rate in diabetic patients and the elderlys

The evaluation of glomerular filtration rate is important in the diagnosis, treatment, and prognosis for patients. Although there are different equations widely used and convenient, the accuracy of them on the specific populations, including diabetic patients and the elderlys, still needs further discussion. We recommend using the Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI)from creatinine and cystatin C in the elderlys. For diabetic patients, however, this equation should be recommended with cautions. (Chin J Endocrinol Metab, 2016, 32: 1036-1040) Key words: Glomerular filtration rate; Estimating equation; Diabetes mellitus; Elderly

Clinical analysis of plasma cystatin-C levels in patients with primary hypertension and obstructive sleep apnea syndrome

Objective To explore the influence of obstruction sleep apnea syndrome (OSAS) on plasma cystatin C (CC) levels in patients with primary hypertension. Methods A total of 244 cases of primary hypertension patients was chosen. The patients were divided into observation group (with OSAS) and control group (without OSAS) according to apnea hypopnea index (AHI). The observation group was then divided into three subgroups: mild OSAS group, moderate OSAS group, and severe OSAS group. The levels of CC were compared. Results First, the plasma CC levels in patients with primary hypertension had no statistical significance in the differences among different grades of hypertension (P>0.05). Second, CC levels of observation group were significantly higher than control group (P 0.05). Conclusions The patients with OSAS and primary hypertension had higher levels of CC, and aggravated with the progress of the degree of obstruction. CC may be involved in the progression of the disease, a high level of CC may aggravate the condition, it should be early prevention and treatment. Key words: Hypertension/CO/ME; Sleep apnea, obstructive/CO/ME; Cysteine proteinase inhibitors/ME

Influencing factors and interpretation of the clinical laboratory assay result of acute kidney injury

More and more laboratory indicators including serum creatinine, serum cystatin C, urinary microalbumin, N-acetyl- beta- D- Glucosaminidase (NAG), kidney injury molecule 1 (KIM-1), neutrophil gelatinase- associated lipocalin (NGAL), interleukin 18 (IL-18) and L type fatty acid binding protein (L-FABP) are used to diagnose and monitor acute kidney injury (AKI). However, the clinical applicability and limitations of these indicators, as well as the detection effect factors and biological variation on the diagnosis and monitoring of AKI are very important, especially how to combine the detection effect factors and biological variation to interpret test result is attached great importance by the laboratory personnel.(Chin J Lab Med, 2016, 39: 879-884) Key words: Acute kidney injury; Creatinine; Cystatin C

Proper report of estimated glomerular filtration rate in clinical laboratory

Estimated glomerular filtration rate(eGFR) is important for diagnosis and staging of chronic kidney disease(CKD), disease risk evaluation and prediction of prognosis, precise dosing and public health management. Automatic reporting eGFR when creatinine and/or cystatin C is measured could improve the quality of service of clinical laboratory. Here we discussed the clinical significance of automatic reporting of eGFR, the status of automatic reporting of eGFR at home and abroad, and matters needing attention when eGFR was reported by clinical laboratory.Wish eGFR to play a better role in clinical practice.(Chin J Lab Med, 2016, 39: 887-890) Key words: Rena insufficiency, chronic; Glomerular filtration rate; Creatinine

Relationship between Cystatin C, Retinol-binding Protein 4 and Framingham Risk Score in Healthy Postmenopausal Women.

We aimed to examine the relationship between high levels of cystatin C, retinol-binding protein 4 (RBP4) and cardiovascular risk score [determined by Framingham Risk Score (FRS)] in postmenopausal women. A total of apparently healthy 129 postmenopausal women (mean age 57.1 ± 4.6 years) were included. Serum cystatin C, RBP4, glucose, lipid parameters, creatinine, uric acid and high sensitivity C-reactive protein (hsCRP) were determined. Anthropometric parameters and blood pressure were also obtained. FRS was calculated. Multiple linear regression analysis (MLR) was performed to identify independent factors affecting FRS and to estimate the final predictors of its variability. Receiver Operating Characteristic (ROC) curve analysis was used with the purpose of testing discriminatory potential of a group of parameters selected in MLR analysis, with FRS level as dependent variable. We found significantly higher levels of both proteins, cystatin C (P = 0.001) and RBP4 (P = 0.006), in the FRS higher (medium and high) risk groups (FRS ≥ 10%) compared to low risk FRS group (FRS < 10%). MLR revealed the best model consisting of 4 parameters (e.g., body mass index (BMI) (P < 0.001), triglycerides (TG) (P = 0.004), RBP4 (P = 0.021), and cystatin C (P = 0.046), R2-adjusted = 0.347) for FRS prediction. Construction of a model consisted of those 4 FRS formula independent parameters (BMI, TG, cystatin C and RBP4) using logistic regression analysis showed that new ROC curve had excellent discriminatory capability (area under the curve = 0.820). High cystatin C and retinol-binding protein 4 may contribute significantly to cardiovascular risk burden in addition to traditional cardiovascular markers.

Glomerular filtration rate assessed by using creatinine and cystatin in patients treated with dabigatran

Dabigatran (DAB) is 80 % renally excreted. Glomerular filtration rate (GFR) estimation is recommended to evaluate the kidney function for DAB dosage adjusting. In this paper we report same results about evaluation of creatinine (CRE) GFR and cystatin-C (CYS) GFR in comparison with drug concentration in a group of patients treated with DAB. We considered 77 patients in which an evaluation of kidney function using CRE and CYS based GFR was performed. After GFR-CRE and GFR-CYS calculation these patients were classified as recommended by KDIGO guidelines. Moreover we evaluated the relationship between trough DAB concentration and GFR-CRE or GFR-CYS. We observed a satisfactory correlation between GFR-CRE and GFR-CYS ( $R=0.85$ ). Following KDIGO criteria, patients’ classification performed by using GFR-CRE or GFR-CYS was concordant in 52 (68 %) subjects and discordant in 25 (32 %). We observed an inverse relationship between trough DAB concentration versus GFR-CRE ( $R=-0.71$ ) and GFR-CYS ( $R=-0.79$ ). Results obtained in this study, although preliminary, suggested that, in this particular subset of patients, the determination of GFR-CYS can be a better renal function indicator than GFR-CRE. Moreover, we observed that GFR evaluation alone is not able to explain in a satisfactory manner, individual responses to dabigatran etexilate evaluated as a trough DAB concentration.

Effects of applying ulinastatin in donors and recipients on the renal function of recipients in the living donor renal transplantation and the mechanism of renal protection

Objective To investigate the effects of ulinastatin(UTI) on renal function and the mechanism of renal protection, when using UTI in donors and recipients in living donor renal transplantation. Methods Forty pairs of patients were randomly assigned into two groups: the ulinastatin group(group U) and the control group(group C). One hour before blocking renal artery, the donors in group U were given ulinastatin 500 U/kg (dissolved in 50 ml saline) for 20 min by intravenous pump, when the renal blood vessels opening, the recipients in group U were infused ulinastatin 500 U/kg (dissolved in 50 ml saline) for 20 min. The donors and recipients in group C received 50 ml saline solution in the same way. The serum thromboxane B2(TXB2), 6-ketone-prostaglandin F1α(6-keto-PGF1α) levels and the TXB2/6-keto-PGF1α were compared before anesthesia induction(T1), 15 min before vessels opening(T2), vessels opening immediately(T3), the end of the operation(T4), 6 h after surgery (T5), 24 h after surgery (T6) in two groups. The serum creatinine(Scr) and cystatin C(CysC) levels were detected and urine volume was recorded at T1, T6 and 48 h after surgery (T7). Results Compared with T1, the serum TXB2 levels in two group were significantly increased at the time points of T2-T6(P 0.05). Conclusions UTI can protect renal function during related donor kidney transplantation, which is related to effectively correct the TXA2/PGI2 proportional unbalance to improve renal blood perfusion. Key words: Living donor renal transplantation; Ulinastatin; Thromboxane A2; Prostacyclin I2; Ischemia/reperfusion injury

Relationships of Blood Pressure Circadian Rhythm and Brain Natriuretic Peptide with Left Ventricular Hypertrophy in the Patients with Primary Hypertension.

Objective To investigate the relationships of blood pressure circadian rhythm and brain natriuretic peptide (BNP) with left ventricular hypertrophy (LVH) in patients with primary hypertension. Methods Totally 349 patients (74 with LVH and 275 without LVH) with primary hypertension were enrolled in this study.Echocardiography was performed to determine left ventricular mass index (LVMI) using the Devereux formula. The nocturnal blood pressure decline rate,24-hour blood pressure (24 h PP; especially 24 h mean systolic blood pressure,24 h SBP) and blood pressure index (PPI) were determined by 24 h-ambulatory blood pressure monitoring. These 349 hypertensive patients were divided into four groups including supper-dipper group (defined as≥;20%, n=7),dipper group (defined as 10%- 20%, n=77),non-dipper group (defined as 0- 10%, n=173),and anti-dipper group (defined as<0, n=92). The baseline demographic characteristics of patients were collected. Fasting blood sugar,blood lipids,blood urea nitrogen,serum cretinine,cystatin C,uric acid,and plasma BNP level were measured. Results The patients with LVH (n=74) had significantly higher percentage of grade 3 hypertension (85.1% vs. 46.9%;χ2=34.428,P<0.001),24 h SBP (134 mmHg vs. 129 mmHg; t=3.175,P=0.002)(1 mmHg=0.133 kPa),daytime-mean SBP (134 mmHg vs. 130 mmHg; t=2.197,P=0.029),night-mean SBP(132 mmHg vs. 121 mmHg; t=4.763,P<0.001),and 24 h PP(57 mmHg vs. 52 mmHg; t=4.120,P<0.001) and PPI (0.43 vs. 0.41; t=3.335,P=0.001) and lower nocturnal blood pressure decline rate [(1.30±8.02)% vs. (5.68±7.25)%; t=-4.510,P<0.001] than the non-LVH patients (n=275). The LVH hypertensive group had significantly higher BNP level (87.8 pg/ml vs. 28.8 pg/ml; t=2.170,P=0.034) and LVMI (135.1 g/m2 vs. 88.7 g/m2; t=15.285,P<0.001) than the control group. No significant difference was observed in the BNP level among supper-dipper,dipper,non-dipper and anti-dipper groups (P=0.137).However,the difference was statistically significant in the LVMI (P=0.001). Additionally,patients in the anti-dipper group had significantly higher LVMI than those in the dipper patients (100.3 g/m2 vs. 86.3 g/m2; t=4.335,P<0.001) and non-dipper (100.3 g/m2 vs.93.7 g/m2; t=1.987,P=0.048). Patients in the non-dipper group had significantly higher LVMI than those in the dipper group (93.7 g/m2 vs. 86.3 g/m2; t=2.693,P=0.008). The multivariate linear correation analysis and logistic regressions analysis suggested a significant correlation of LVMI with BNP and the grade of hypertension. Conclusion With the increasing of plasma BNP level,the left ventricular hypertrophy is closely related to abnormal blood pressure circadian rhythm and the grade of hypertension in primary hypertensive patients.

Cystatin (C) as a predictor of coronary artery disease in subclinical atherosclerotic hypertensive patients

Background/aimsThe aim of this work is to discuss the role of cystatin C (CyC) as an early predictor biomarker of coronary artery disease (CAD) in subclinical atherosclerotic and hypertensive patients. Subjects and methods120 patients were included in this study. They divided into three groups; 40 normal individuals, 40 hypertensive patients with subclinical atherosclerosis and without CAD, and 40 hypertensive patients with CAD. ResultsBy doing ROC curve, the cutoff point of CyC was 0.93mg/l and its accuracy for early prediction of CAD was 90.5% with specificity as 76.3%, sensitivity of 97.1%, positive predictive value was 91.5%, and negative predictive value was 96.7%. ConclusionOur finding advice population-based follow-up studies to establish the role of cystatin in preventive cardiology.

Effect of intravenous combined with oral hydration in the prevention of contrast induced nephropathy in patients with chronic renal insufficiency

Objective To compare the effect of intravenous combined with oral hydration and routine hydration in the prevention of contrast induced nephropathy in patients with chronic renal insufficiency. Methods A total of 48 patients who were undergoing percutaneous coronary intervention or diagnosis were randomized divided into the short-time hydration group (25 cases) and the conventional hydration group (23 cases). Patients in the short-time hydration group received intravenous hydration at 3 ml/(kg·h) from 1 hour before the operation to 4 hours after the operation, and oral hydration at 1 ml/(kg·h) rate from 4 hours before the operation to 10 hours after the operation. Patients in the conventional hydration group received intravenous hydration at 1 ml/(kg·h) from 12 hours before the operation to 12 hours after the operation. Levels of Serum creatinine (Scr) and Cystatin C (CysC) were measured 1 d, 2 d and 3 d preoperative and postoperative, and the incidence of contrast induced nephropathy between two groups was statistically analyzed. Results There was no significant difference in blood Scr, CysC of 1 d, 2 d and 3 d preoperative and postoperative and incidence of contrast nephropathy between two groups (P>0.05). Conclusions The effect of short time intravenous combined with oral hydration and routine hydration in the prevention of contrast induced nephropathy has no difference in patients with chronic renal insufficiency. Key words: Renal insufficiency, chronic; Intravenous hydration; Oral hydration; Contrast-induced nephropathy

Establishment of reference ranges for serum cystatin C in healthy middle-aged and elderly Chinese individuals

Objective To establish normal reference ranges for serum cystatin C(Cys C)in relatively healthy middle-aged and elderly(>50 years)Chinese individuals. Methods A total of 1087 candidates were consecutively selected and serum Cys-C levels were measured by transmission turbidimetry.Frequency analysis and histogram were used to establish the 95% confidence reference range according to methods provided by CLSI(C28-A2). Results Based on the definition and verification procedures for clinical laboratory reference ranges(CLSI C28-A2, second edition), Cys-C levels of 1087 participants fell within the range of 0.30-1.55 mg/L; Male participants had higher serum Cys-C levels than female participants(Z=-10.19, P<0.01). The serum Cys-C level increased with age, regardless of gender(R=0.600, P<0.01). Differences in Cys-C levels between age groups were statistically significant(χ2=411.17, P<0.01). The reference ranges of normal serum Cys-C levels for different age groups(50-, 55-, 60-, 65-, 70-, 75-, )were 0.42-0.98mg/L, 0.45-1.04mg/L, 0.47-1.34mg/L, 0.46-1.38mg/L, 0.61-1.33mg/L, 0.61-1.28 mg/L, respectively, for males, and 0.39-0.94mg/L, 0.42-1.01mg/L, 0.40-0.91mg/L, 0.46-1.03mg/L, 0.57-1.04mg/L, 0.55-1.27mg/L, respectively, for females. Conclusions This study established preliminary normal serum Cys-C reference ranges for healthy middle-aged and elderly(>50 years)individuals in this region, which can serve as parameters for disease diagnosis and treatment evaluation. Key words: Cystatin-C; Reference values