血清胱抑素C联合APACHEⅡ评分对重症急性肾损伤患者诊断和预后预测的价值  

Cfinical value of serum cystatin C combined with APACHE Ⅱscore in diagosis and predicting prognosis of critically ill patients with acute kidney injury

作　　者：池锐彬[1] 古伟光[1] 梁美华[1] 罗醒政[1] 简志刚[1] 刘力新[1] 袁婕[2] 陈纯波[2] 

机构地区：[1]南方医科大学附属小榄医院重症医学科,广东中山528415 [2]广东省人民医院重症医学科,广东广州510080

出　　处：《中国中西医结合急救杂志》2016年第4期404-407,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：广东省公益研究与能力建设重点专项（20148020212023）;广东省中山市科技攻关项目（201681083）

摘　　要：目的探讨血清胱抑素C（sCysC）联合急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分对重症急性肾损伤（AKI）患者诊断和预后的预测价值。方法采用前瞻性观察性研究方法，选择2015年3月至11月入住南方医科大学附属小榄医院重症加强治疗病房（ICU）的重症患者134例。根据改善全球肾脏病预后组织（KDIGO）标准将患者分为非AKI组（80例）和AKI组（56例，其中轻症AKI组32例，重症AKI组24例）；比较各组患者sCysC水平及APACHEⅡ评分，运用受试者工作特征曲线（ROC）及曲线下面积（AUC）评价sCysC联合APACHEⅡ评分后对AKI的诊断和预后的预测价值。结果136例重型患者中有56例发生AKI。AKI发生率为41．2％。AKI组患者sCysC水平和APACHEⅡ评分明显高于非AKI组[sCysC（mg／L）：1．2（0．9，1．6）比0．6（0．5，0．8），APACHEⅡ评分（分）：26（22，32）比18（13，22），均P〈0．05]。重症AKI组sCysC水平和APACHEⅡ评分均明显高于非AKl组和轻症AKI组【sCysC（mg／L）：1．5（1．1，1．9）比0．6（0．5，0．8）、1．0（0．8，1．4），APACHEⅡ评分（分）：28（23，35）比18（13，22）、23（16，26），均P〈0．05]。sCysC及APACHEⅡ评分预测AKI的AUC分别为0．88、0．83，预测重症AKI的AUC分别为0．90、0．82；两者联合后预测AKI及重症AKI的AUC分别为0．93、0．94，均明显高于单一指标（均P〈0．05）。AKI组住院病死率[16．1％（9／56）比5．0％（4／80）]及肾脏替代治疗率[19．6％（11／56）比1．3％（1／80）]均明显高于非AKI组（均P〈0．05）。结论sCysC是预测重症患者发生AKI及预后的敏感指标，与APACHEⅡ评分联合后可进一步提高对重症患者发生AKI和短期预后的预测能力。Objective To explore the clinical value of serum cystatin C （sCysC） combined with acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score in diagnosis and predicting prognosis of acute kidney injury （AKI） in adult critically ill patients. Methods A prospective observation was conducted. 134 adult critically ill patients admitted to the intensive care unit （ICU） of Xiaolan Hospital of Southern Medical University during March 2015 to November 2015 were enrolled. According to the Kidney Disease Improving Global Outcomes （KDIGO） criterion, the patients were divided into non-AKI group （80 cases） and AKI group （56 cases including mild AKI 32 cases and severe AKI 24 cases）. The levels of sCysC and APACHE Ⅱ score were compared between the two groups. The receiver operating characteristic curve （ROC） and the area under the curve （AUC） were applied to evaluate the predictive values of sCysC combined with APACHE Ⅱ score for diagnosis and prognosis of AKI. Results Fifty-six cases with AKI occurred in 136 critically ill patients, the incidence being 41.2%. The levels of sCysC and APACHE Ⅱ score in AKI group were significantly higher than those in non-AKI group [sCysC （mg/L）： 1.2 （0.9, 1.6） vs. 0.6 （0.5, 0.8）, APACHE Ⅱ score： 26 （22, 32） vs. 18 （13, 22）, both P 〈 0.05]. The level of sCysC and APACHE lI score in severe AKI group were significantly higher than those in non-AKI and mild AKI groups [sCysC （rag/L）： 1.5 （1.1, 1.9） vs. 0.6 （0.5, 0.8）, 1.0 （0.8, 1.4）, APACHE Ⅱscore： 28 （23, 35） vs. 18 （13, 22）, 23 （16, 26）, all P 〈 0.05]. The AUCs of sCysC and APACHE Ⅱ score for predicting AKI were 0.88 and 0.83 respectively, and AUCs for predicting severe AKI were 0.90 and 0.82 respectively; after combination of above two biomarkers, the AUCs for predicting AKI and severe AKI were 0.93 and 0.94 respectively, higher than those of any single biomarker （all P 〈 0.05）. The in-hospital mortality [16.1% （9/56�

关 键 词：肾损伤 急性 胱抑素C 急性生理学与慢性健康状况评分系统Ⅱ评分 诊断 预后 

分 类 号：R576[医药卫生—消化系统]