血清胱抑素C在两性霉素B所致肾损害中检测的意义  

Clinical significance of the serum levels of cystatin C in detecting amphotericin B nephrotoxicity

作　　者：孙道萍[1] 陈文明[1] 孙忠亮[1] 葛善义[1] 陈继英[1] 

机构地区：[1]济宁市第一人民医院血液科,山东济宁272100

出　　处：《中国病原生物学杂志》2012年第8期623-625,611,共4页Journal of Pathogen Biology

摘　　要：目的探讨血清胱抑素C(CysC)水平在监测两性霉素B所致肾功能损害中的意义。方法检测25例恶性血液病化疗后肺部霉菌感染者应用两性霉素B治疗前后血清CysC、血清肌酐(Scr)、血β2微球蛋白(β2-MG)及肌酐清除率(Ccr)的水平变化,分析血清CysC、Scr、β2-MG与Ccr的相关性,并比较血清CysC、Scr、β2-MG对两性霉素B相关肾功能损害的诊断价值。结果与治疗前相比,两性霉素B治疗后Ccr显著下降,血清CysC及β2-MG水平显著升高(P均<0.05),而血清Scr水平较前升高,但差异无统计学意义(P>0.05)。两性霉素B组治疗前后Ccr分别和血清CysC、β2-MG水平间均存在显著相关性(r分别为-0.855,-0.883,-0.698,-0.486,P均<0.05),而与血清Scr水平无相关性(治疗前后r分别为0.435,0.472,P>0.05)。以Ccr下降20%以上作为诊断肾功能损害标准时,血清CysC ROC曲线下面积为0.938±0.030,显著高于血清Scr及β2-MG的曲线下面积(分别为0.801±0.070,0.884±0.055,P均<0.05)。结论血清CysC与Scr、β2-MG相比,能更敏感准确地反映两性霉素B相关肾损害。Objective To evaluate the diagnostic significance of serum cystatin C levels in detecting amphotericin B nephrotoxicity.Methods Subjects were 25 patients with hematologic malignancies and invasive fungal infection after chemotherapy who underwent amphotericin B therapy.Peripheral blood was collected from patients at different times before and after amphotericin B therapy.Serum levels of cystatin C（CysC）,creatinine（Scr）,and β2-microglubin（β2-MG） were determined and the creatinine clearance rate（Ccr） was also calculated.The correlation between Ccr and the serum levels of CysC,Scr,and β2-MG was evaluated.The receiver operating characteristic（ROC） curve for serum CysC,Scr,and β2-MG was determined and the area under the curve（AUC） was calculated.Results（1）After amphotericin B therapy,Ccr decreased significantly,while the serum levels of CysC and β2-MG increased significantly（P〈0.05）.However,there was no significant increase in serum Scr levels before and after amphotericin B therapy（P〉0.05）.（2） Before and after amphotericin B therapy,Ccr inversely correlated with the serum levels of both CysC and β2-MG（r of-0.855,-0.883,-0.698,and-0.486,respectively,P〈0.05）.However,there was no significant correlation between Ccr and serum Scr both before and after amphotericin B therapy（r of 0.435,0.472 respectively,P〉0.05）.（3） A reduction in Ccr of more than 20% was defined as nephrotoxicity.The AUC for CysC（0.938±0.030） was significantly higher than that for β2-MG and CysC（0.801±0.070 and 0.884±0.055,P〈0.05）.Conclusions Serum levels of CysC are more accurate and sensitive at detecting amphotericin B nephrotoxicity than Scr and β2-MG.

关 键 词：胱抑素C 两性霉素B 肾功能损害 肌酐 肌酐清除率 Β2微球蛋白 

分 类 号：R379[医药卫生—病原生物学]