血清半胱氨酸蛋白酶抑制剂C在肾移植功能监测中的应用价值  

Application of cystatin C as an efficacious marker of renal function in kidney transplant recipients

作　　者：王盛华[1] 杨晓静[1] 邹雄[1] 

机构地区：[1]山东大学齐鲁医院检验科,济南250012

出　　处：《中华检验医学杂志》2007年第11期1223-1226,共4页Chinese Journal of Laboratory Medicine

摘　　要：目的探讨血清半胱氨酸蛋白酶抑制剂 C(Cys C)在肾移植术后,尤其是感染和排斥时,监测肾功能的临床应用价值。方法同时检测65例肾移植患者术前、术后1个月内、感染或排斥发生时及次日血清中 Cys C 和血清肌酐(Scr)的浓度,并测定30名健康人和30例非移植感染患者的Cys C 和 Scr 作为对照。结果健康人与非肾移植感染患者的 Cys C 浓度差异无统计学意义(P=0.32)。移植后肾功能稳定组(n=36)术后前3 d 内 Cys C 分别较术前下降了69.2%、74.7%、75.8%(P<0.01),Scr 相应的下降了38.4%、74.5%、81.4%(P<0.01)。移植术后感染组(n=13)。肾功能异常时,Cys C 比 Scr 早(4.4±1.5)d 升高,升高幅度分别为39.4%和35.3%(P=0.43);排斥组(n=16)Cys C 比 Scr 早(2.7±1.8)d 升高,升高幅度分别为148.9%和43.9%(P=0.0069)。与肾功能稳定组作横向比较,术后感染组和排斥组的 Cys C 分别升高了38.7%和108.5%(P<0.001),Scr 分别升高了34.2%和89.5%(P<0.001)。所有肾移植患者术后3～28 d 之间,Cys C 与 Scr 呈线性正相关(r=0.785,P<0.0001)。根据 ROC 曲线确定 Cys C 和 Scr 在术后排斥时的临界值分别为1.79 mg/L和122 μmol/L。排斥组 Cys C 的敏感度、特异度、阳性预测值、阴性预测值、符合率以及曲线下面积(AUC)均优于 Scr(均 P<0.05)。结论 Cys C 优于 Scr,是一个能早期、灵敏、准确判断移植肾功能变化的血清标志物。Objective To assss the clinical significance of Cystatin C （ Cys C） as a marker of renal function in kidney transplant patients especially when infection or acute rejection occured. Methods Among 65 renal transplant recipients the concentrations of serum Cys C and serum creatinine （Scr） were determined before and one month after the transplantation, and also in the day and next day of occurrence of infection or rejection. Meanwhile, 30 healthy persons and 30 infected patients without kidney transplantations were served as control. Results The concentrations of Cys C were nearly equal between healthy persons and the infected patients without kidney transplantations （ P = 0. 32）. The level of serum Cys C and Scr dropped quickly in the first 3 days after transplantation （ decreased by 69. 2% , 74.7%, 75.8% for Cys C and 38.4% , 74.5% , 81.4% for Scr） （ P 〈 0. 01 ）. When infection occured, Cys C level increased （4. 4 ± 1.5 ） days earlier than Scr did, and the level of serum Cys C and Scr increased by 39.4% and 35.3% respectively（ P = 0.43 ）. When acute rejection occured, Cys C level increased（2. 7 ± 1.8 ） days earlier than Scr did, and the level of serum Cys C and Scr increased by 148.9% and 43.9% respectively （ P = 0. 0069 ）. Compared with the level of stable state, Cys C increased by 38. 7% and 108.5% during level of infection group and rejection group （ P 〈 0. 001 ）, while Scr increased by 34. 2% and 89. 5% respectively （ P 〈 0. 001 ）. During the postoperative day 3 to day 28, there was a positive correlation between Cys C and Scr （r =0. 785 ,P 〈 0. 0001 ）. ROC analysis showed the cut-off value of rejection group for Cys C and Scr were 1.79 mg/L and 122 μmol/L respectively. The sensitivity, specificity, positive predictive value, negative predictive value, coincidence rate and AUC in rejection group for Cys C were better than that for Scr （ P 〈 0.05 ）. Conclusion Cys C is superior to Scr in reflecting the early changes of renal function, with high s

关 键 词：肾移植 胱抑素C 排斥 感染 

分 类 号：R446.1[医药卫生—诊断学]