基于血清胱抑素C的肌酐清除率在急性肾损伤中的临床价值  

Value of creatinine clearance rate estimated based on serum cystatin C in patients with acute kidney injury

作　　者：胡军涛[1] 谢显龙[1] 汤展宏[1] 李超乾[1] 周红卫[1] 

机构地区：[1]广西医科大学第一附属医院重症医学科,南宁530021

出　　处：《中国危重病急救医学》2012年第9期534-537,共4页Chinese Critical Care Medicine

基　　金：国家临床重点专科建设项目（2011-873）;广西自然科学基金面上项目（2011GXNSFA018269）

摘　　要：目的探讨基于血清胱抑素C（SCysC）的肌酐清除率（SCysC—CCr）对急性肾损伤（AKI）患者诊断以及预测AKI患者是否需要肾脏替代治疗（RRT）的价值。方法收集2010年8月至2011年5月本院重症监护病房（ICU）入住超过3d的患者，以住ICU期间是否诊断为AKI将患者分为AKI组（21例）和非AKI组（30例），根据每日测定的SCysC和血清肌酐（SCr）分别计算肌酐清除率（SCysC—CCr和SCr—CCr），并统计尿量及急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分。比较两种方法计算的肌酐清除率在AKI中的诊断价值以及与RRT的关系。结果AKI组入院时、确诊前2d、前1d及当日SCr—CCr和SCysC—CCr均较非AKI组显著下降。其中AKI组在诊断AKI前2d，SCysC—CCr（ml·min-1·1．73m-2）较入院时明显降低（70．6±8．4比114．8±15．8，P〈0．01），SCr—CCr（ml·min-1·1．73m-2）无明显变化（76．4±19．3比78．7±22．1，P〉0．05）。受试者T作特征曲线（ROC曲线）分析显示，SCysC—CCr较SCr—CCr能更早发现AKI，AKI确诊前2d的曲线下面积（AUC）分别为0．859和0．664，敏感性分别为90．5％和47．6％，特异性分别为76．2％和81．0％。AKI组中6例行RRT者较15例未行RRT者入院时APACHEⅡ评分（分）更高（29．6±4．5比17．0±5．6，P〈0．05），24h尿量（m1）更少（740±465比1780±1230，P〈0．05），而SCysC—CCr则无差异（50．4±11．2比53．0±8．4，P〉0．05）。在AKI确诊当日，SCysC—CCr并不能很好地预测AKI患者是否需要行RRT（AUC=0．65）。结论SCysC—CCr敏感性较高，但特异性不高，对有AKI高危因素的患者有助于排除AKI，而在AKI诊断当日SCysC—Ccr并不能预测患者是否需行RRT治疗。Objective To investigate diagnostic value of creatinine clearance rate （CCr） based on serum cystatin C （SCys C ） in acute kidney injury （AKI）, and whether it could predict the need for renal replacement therapy （RRT）. Methods The patients enrolled with the length of intensive care unit （ICU） stay over 3 days were collected from August 2010 to May 2011. According to the diagnosis of AKI during the ICU stay, patients were divided into the AKI group （n =21 ） and non-AKI group （n =30）. After patients were admitted, the level of SCysC and creatinine （SCr） were measured so as to count CCr based on SCys C （SCys C-CCr） or on SCr （SCr-CCr） respectively, meanwhile urine volume and acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score were monitored. The value of CCr counted by SCys C and SCr on predict AKI and the correlations between RRT were compared. Results SCr-CCr and SCys C-CCr in AKI group both were significantly lower than non-AKI group all the way through on admission, and 2 days and 1 day before AKI diagnosed and the day AKI diagnosed. The level of SCys C-CCr （ml·min-1-1.73 m-2） on 2 days prior to AKI diagnosed was significantly lower than the day admitted （70.6 ± 8.4 vs. 114.8 ±15.8, P〈0.01 ）, whereas the level of SCr-CCr （ml·min-1·1.73 m-2） were not significantly changed （76.4 ± 19.3 vs. 78.7 ± 22.1, P〉 0.05 ）. Receptor operative curve （ ROC ） analysis indicated that SCys C-CCr could predict AKI earlier than SCr-CCr, as the area under curve （AUk） of SCys C-CCr and SCr-CCr on 2 days prior to AKI diagnosed were 0.859 and 0.664, respectively, and the sensitivity were 90.5% and 47.6%, the specificity were 76.2% and 81.0%. In AKI group 6 patients were treated with RRT, the AKI patients receiving RRT had significantly higher APACHE Ⅱ score on admission （29.6 ± 4.5 vs. 17.0 ± 5.6, P〈0.05 ） and less urine volume （ml） within 24 hours （740 ±465 vs. 1780 ± 1230, P〈 0.05 ） than patients not received RRT, ho

关 键 词：胱抑素C 肾损伤 急性 肌酐 肌酐清除率 肾脏替代治疗 

分 类 号：R692[医药卫生—泌尿科学]