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目的:探讨胱抑素C(CysC)水平对老年冠状动脉介入治疗(PCI)患者术后造影剂诱导的急性肾损伤(CI-AKI)发生及其远期预后的影响。方法:前瞻性连续入选2015年3月至2017年12月间在我院心内科接受PCI治疗的老年患者848例，CI-AKI定义为应用碘造影剂48～72 h内血清肌酐升高≥44.2 μmol/L，或较基础水平升高25%以上。采用受试者工作特征曲线分析评价CysC预测PCI术后CI-AKI发生的最佳截断值，根据最佳截断值(CysC＝1.3 mg/L)分为高CysC组(CysC≥1.3 mg/L，178例)和对照组(CysC<1.3 mg/L，670例)，比较两组患者PCI术后CI-AKI发生及随访1年主要心脏不良事件(MACE)发生率的差异，并进一步采用Cox回归模型分析PCI术后远期预后的预测因素。结果:848例患者PCI术后发生CI-AKI的比例为9.4%。根据CysC水平，发现高CysC组PCI术后1年MACE发生率高于对照组[15.7%比9.3%，n χ2＝6.524，n P＝0.011)]；Cox回归分析显示高CysC(≥1.3 mg/L)水平是PCI术后1年MACE发生的最强预测因素(n HR＝16.244，n P<0.001)。n 结论:基线高CysC水平(≥1.3 mg/L)是老年患者PCI术后CI-AKI的独立危险因素，也是老年患者PCI术后远期MACE发生的最重要预测因素。“,”Objective:To investigate the effect of serum cystatin C level on the occurrence and its long-term prognosis of contrast agent-induced acute kidney injury(CI-AKI)after percutaneous coronary intervention(PCI)in elderly patients.Methods:A total of 848 elderly patients(≥60 years)undergoing PCI in our department between Mar 2015 and Dec 2017 were enrolled in a prospective cohort.The CI-AKI was defined as the increase of serum creatinine ≥44.2 μmol/L within 48-72 h after using iodine contrast agent or more than 25 % higher than base level within 48-72 h after PCI.A receiver operating characteristic curve was used to analyze the optimal cut-off value of Cystatin C for predicting CI-AKI after PCI.Patients were divided into 2 groups based on the optimal cut-off value of Cystatin C: the high Cystatin C group(Cystatin C ≥1.3 mg/L, n=178)and the control group(Cystatin C<1.3 mg/L, n=670). The differences in the incidence of CI-AKI after PCI and major adverse cardiac events(MACE)at 1 year follow-up were compared between the two groups.The Cox regression model was further used to analyze the predictors of the long-term prognosis after PCI.Results:Of 848 patients receiving PCI, the incidence of CI-AKI was 9.4%.The incidence of MACE at 1 year after PCI was higher in the high Cystatin C group than in the control group(15.7% n vs.9.3%, n χ2=6.524, n P=0.011). Cox regression analysis confirmed that the high baseline level of Cystatin C was the most independent predictive factor for MACE at 1 year of follow-up(n HR=16.244, n P<0.001).n Conclusions:The high baseline level of Cystatin C(≥1.3 mg/L)is an independent risk factor for CI-AKI and is also the most important predictor for the occurrence of long-term MACE in elderly patients undergoing PCI.