血清胱抑素C、内生肌酐清除率及尿微量白蛋白在恶性肿瘤含顺铂化疗患者肾功能评价中的地位  

Measurement of serum cystatin C,creatinine clearance and urea microalbuminuria as renal function evaluation for patients with malignant tumors during chemotherapy containing platinum

作　　者：蔡讯[1] 薛鹏[1] 宋卫峰[1] 胡炯[1] 顾鸿莉[1] 杨海燕[1] 王理伟[1] 

机构地区：[1]上海交通大学附属第一人民医院肿瘤科,上海200080

出　　处：《中国癌症杂志》2010年第10期764-768,共5页China Oncology

摘　　要：背景与目的:化疗药物可能对肾功能造成损害,内生肌酐清除率(creatinine clearance,Ccr)作为临床评价肾功能的"金标准"因检测较为繁琐而在应用上受到限制,本研究分别测定恶性肿瘤患者化疗前后血清胱抑素C(cystatin C,Cys C)、Ccr及尿微量白蛋白(urea micro-albuminuria,UMA)水平,分析和探讨三者在评价肾功能中的作用和地位。方法:对110例晚期恶性肿瘤患者,检测其化疗前后血清Cys C、血清肌酐及UMA等指标,并计算Ccr,分析三者在接受含铂与非铂方案化疗前后是否存在差异,以及对于肾功能轻度受损的患者(Ccr 50～75 mL/min)Cys C和UMA在化疗前后有无差异。结果:接受含铂方案化疗的患者Ccr、Cys C和UMA在化疗前后存在差异[(85.01±28.40)mL/min vs(76.79±26.63)mL/min、(1.49±0.50)mL/min vs(1.80±0.84)mg/L和(14.30±9.15)mL/min vs(16.90±10.95)mg/L,P=0.00、0.00和0.01],而非铂方案化疗的患者则无差异[(89.45±29.69)mL/min vs(86.78±27.96)mL/min、(1.51±0.78)mL/min vs(1.63±0.73)mg/L和(17.31±10.46)mL/min vs(16.59±8.33)mg/L,P=0.45、0.07和0.57];治疗后肾功能轻度受损的患者Cys C在化疗前后有差异[(1.68±0.55)mL/min vs(2.04±0.68)mg/L,P=0.03],而UMA则无差异[(21.11±10.06)mL/min vs(21.22±8.81)mg/L,P=0.93],其中含铂组Cys C和UMA在化疗前后均有差异,但UMA敏感性不如Cys C。结论:Cys C和UMA均能监测化疗后早期肾功能损害的情况,但UMA敏感性不如Cys C,因此Cys C可以作为替代Ccr对患者肾功能进行评估的可靠指标。Background and purpose：Chemotherapy drugs such as platinum may cause damage to renal function.Creatinine clearance（Ccr）,known as a ＂golden standard＂ indicator in clinical evaluations of renal function,was limited in its application due to detected complications.This study was designed to analyze and discuss their roles and status in renal function by measuring and evaluating the levels of serum Cystatin C（Cys C）,Ccr and uria urea micro-albuminuria（UMA） in order to benefit patients with malignant tumors before and after chemotherapy.Methods：Among 110 patients,the levels of Cys C,Ccr were calculated using the Cockcroft-Gault equation.The levels of Cys C,Ccsaas well as UMA were then analyzed in patients who received platinum-containing protocols or non-platinum containing ones.Patients with mildly impaired renal function（Ccr between 50-75 mL/min） were also evaluated for differences among Cys C and UMA before and after chemotherapy.Results：There were significant differences for Ccr,Cys C and UMA in patients who received platinum-containing protocols [（85.01±28.40） vs（76.79±26.63） mL/min,（1.49±0.50） vs（1.80±0.84） mg/L and（14.30±9.15） vs（16.90±10.95） mg/L,P=0.00,0.00 and 0.01）],but no significant differences for those receiving non-platinum-containing ones [（89.45±29.69） vs（86.78±27.96）mL/min,（1.51±0.78） vs（1.63±0.73） mg/L and（17.31±10.46） vs（16.59±8.33） mg/L,P=0.45,0.07 and 0.57）].There were also significant differences for Cys C in patients with mildly impaired renal function before and after chemotherapy [（1.68±0.55） vs（2.04±0.68） mg/L,P=0.03）],whereas there were no significant differences for UMA for the same ones [（21.11±10.06） vs（21.22±8.81） mg/L,P=0.93）].There were differences for Cys C and UMA before and after chemotherapy in the platinum-containing groups,but Cys C was more sensitive than UMA.Conclusion：Cys C and UMA can monitor renal dysfunction early after chemotherapy,and Cys C is more sensiti

关 键 词：胱抑素C 内生肌酐清除率 尿微量白蛋白 恶性肿瘤 化学治疗 肾功能 

分 类 号：R730.7[医药卫生—肿瘤]