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Objective To investigate the association between serum Cystatin C (Cys C) and subclinical atherosclerosis in elderly people.Methods The cross-sectional study was undertaken on 472 elderly people selected at random from the participants in a physical examination.The medical history of each participant was obtained by questionnaire.The samples of venous blood and the Bilateral B-mode carotid artery images were taken.The association of serum Cys C with carotid intima-media thickness (clMT) and carotid plaque, the markers of subclinical atherosclerosis (AS), were analyzed.Results The levels of Cys C showed skewed and leptokurtic distribution (skewness: 2.23; kurtosis: 12.33).Males [0.66 (0.51~0.80) mg/L] had significantly higher values of Cys C than females [0.58 (0.48~0.69) mg/L], P<0.001.clMT and proportion of carotid plaques in the highest quartile of serum Cys C were significantly higher than that in the lowest quartile, and the increased level in parallel with dose-effect relationship, P trend < 0.001.The levels of Cys C in the increased cIMT group or the carotid plaque group were significantly higher than the control group (P<0.001).Serum Cys C were positively correlated with age, clMT, BMI, TG, hs-CRP, urea, uric acid and creatine (P<0.01), but negatively correlated with TC, HDL-C and creatinine clearance rate (P<0.05).The multifactor logistic regression analysis showed that serum Cys C were not the independent risk factor, while age, hypertension and the increased level of urea were the independent risk factors for increased clMT and smoke history and hypertension were the independent risk factors for carotid plaques.Conclusion The increased level of serum Cys C in elderly people may be caused by aging which leads to the injury of kidney function, blood clotting and blood pressure variation, and it has no direct effect on the development of subclinical AS.