尿胱抑素C预测非少尿型ATN近期结局的临床应用价值  

The clinical application of urinary cystatin C in predicting the short-term outcome of nonoliguric acute tubular necrosis

作　　者：刘进[1] 盛丹[2] 

机构地区：[1]四川泸州医学院附属医院肾内科,646000 [2]广州中医药大学医学院,510405

出　　处：《新医学》2007年第5期295-298,共4页Journal of New Medicine

摘　　要：目的:探讨尿胱抑素C预测非少尿型急性肾小管坏死(acute tubular necrosis,ATN)近期是否需要肾替代治疗(renal replacement therapy,RRT)的临床应用价值。方法:用ELISA法检测64例非少尿型ATN患者(均在发病3日内)的尿胱抑素C水平,观察此64例患者15日后的结局,根据有否行RRT分为RRT组及非RRT组,比较2组进入研究时的血清肌酐水平、尿流速、LIANO积分、尿胱抑素C水平,并比较后两者的接收者工作特征(receiver operating characteristic,ROC)曲线。结果:21例进入RRT组,余43例为非RRT组。2组进入研究时的血清肌酐及尿流速比较,差异均无统计学意义(均为P>0.05);而进入研究时,RRT组的尿胱抑素C水平比非RRT组显著升高(P<0.01);2组的LIANO积分比较差异亦有统计学意义(P<0.05)。通过比较两者的ROC曲线,前者的敏感度、特异度均高于后者。结论:尿胱抑素C在近期结局不同的非少尿型ATN患者中存在明显的差异,可作为预测此类患者是否需要行RRT治疗的指标,其敏感度及特异度均高于LIANO积分,具有重要的临床应用价值。Objective： To study the value of urinary cystatin C in predicting the need of renal placement therapy （RRT） in nonoliguric acute tubular necrosis （ATN）. Methods： Urinary cystatin C was measured by ELISA in 64 patients with nonoliguric ATN and the 15 day-outcome was evaluated. Patients were divided into RRT and non-RRT groups according to whether the patients received RRT. Serum creatinine level, urine flow rate, LLANO scores and the receiver operating characteristic （ROC） curve of cystatin C on entry of the study were compared between the two groups. Results： Twenty-one patients entered the RRT group and 43 patients entered the non-RRT group. Serum creatinine level and urine flow rate on entry was not statistically significant between the two groups. However, the RRT group had significantly higher urinary cystatin C and LLANO score than those of the non-RRT group. Urinary cystatin C had higher sensitivity and specificity in identifying patients requiring RRT than those of LLANO score when comparing the ROC curves. Conclusion： There is significant difference in urinary cystatin C of patients with different short-term outcome of nonoliguric ATN. In- creased urinary cystatin C has important clinical application in predicting patients requiring RRT, with higher sensitivity and specificity than those of LLANO score.

关 键 词：胱抑素C 急性肾小管坏死 肾替代治疗 血清肌酐 尿流速 

分 类 号：R692.5[医药卫生—泌尿科学]