血清胱抑素C及其估算肾小球滤过率在亚临床肝肾综合征诊断中的应用  

Application of Serum Cystatin C and Estimated Glomerular Filtration Rate in Diagnosis of Subclinical Hepatorenal Syndrome

作　　者：何流[1] 陈世银[1] 陈志富[2] 杨发成[3] 张雷[4] 

机构地区：[1]四川省广安市人民医院检验科,四川广安638000 [2]成都医学院第一附属医院检验科,四川成都610000 [3]泸州医学院附属医院检验科,四川泸州646000 [4]第三军医大学附属新桥医院检验科,重庆400038

出　　处：《现代生物医学进展》2016年第34期6742-6745,6792,共5页Progress in Modern Biomedicine

基　　金：四川省卫生厅科研基金项目(090057)

摘　　要：目的:探讨血清胱抑素C(CysC)及其估算肾小球滤过率(eGFR)在肝肾综合征(HRS)诊断中的应用价值。方法:测定218例肝硬化腹水患者的血清CysC和肌酐(Cr)浓度,并采用CKD-EPI 2012 Cr-CysC方程计算其eGFR,分析三者在非HRS和各型HRS患者中的差异,并初步探索血清Cr和eGFR的判断阈值及其在HRS患者中的检出率。结果:血清CysC和Cr间增长倍数的关系方程为:CysC增长倍数=0.608+0.631×Cr增长倍数(R2=0.640,P<0.001)。与Cr增长倍数相比,CysC增长倍数在非HRS患者中明显增高(Z=-10.133,P<0.001),在HRS-1型患者中明显降低(Z=2.725,P=0.006),而在HRS-2型患者中二者的差异无统计学意义(Z=0.715,P=0.474)。以血清Cr和CysC浓度超过基线水平1.5倍,eGFR超过60 mL/min/1.73m2为阳性标准,在非HRS组中,CysC和eGFR的阳性检出率高于Cr,差异均有统计学意义(P<0.001);在HRS组中,CysC的阳性检出率低于Cr,差异有统计学意义(P<0.001),而eGFR阳性检出率与Cr相当;所有肝硬化伴腹水患者中,eGFR的阳性检出率明显高于Cr(P=0.002)。结论:血清CysC和eGFR测定能有助于早期诊断亚临床HRS。相对Cr而言,血清CysC对HRS-2患者不能提供更好的检出率,而且对HRS-1患者会低估其肾功能。Objective： To investigate the application value of serum cystatin C （CysC） and estimated glomerular filtration rate （eGFR） in hepatorenal syndrome （HRS）. Methods： The serum CysC and creatinine （Cr） concentrations were determined in 218 patients with cirrhotic ascites, and the eGFR was calculated by CKD-EPI 2012 Cr-CysC equation. Then the differences of the three above were compared in patients with various type HRS or not, and the thresholds and its detection rates of serum CysC and eGFR were preliminary explored in HRS. Results： The equation between serum CysC and Cr increase ratios as follows： CysC increase ratio = 0.608 ＋ 0.631x Cr increase ratio （R2=0.640, P〈0.001）. Comparing with Cr increase ratio, CysC increase ratio was significant higher in the patients without HRS （Z=10.133, P〈0.001） and significant lower in HRS-1 （Z= -2.725, P=0.006）, but in HRS-2, the difference between the both two was without statistical significance （Z= 0.715, P=0.474）. As a positive criteria by serum Cr and CysC concentrations exceeding the baseline over 1.5 times, and eGFR exceeding 60 ml/min/1.73 m2, in the non-HRS group, the detection rate of CysC and eGFR was higher than that of Cr with statistical significance （P〈0.001）; and in the HRS group, the detection rate of CysC was lower than that ofCr （P= 0.001）, but the detection rate of eGFR was equivalent with Cr （P〉0.05）; and in all patients with cirrhotic ascites, the detection rate of eGFR was much higher than that of Cr. Conclusions： The determination of serum CysC and eGFR can contribute to the early diagnosis of subclinical HRS. Compared with Cr, the serum CysC can＇t provide better detection rate in patients with HRS-2, and it will underestimate the renal function in patients with HRS-1.

关 键 词：肝肾综合征 胱抑素C 估算肾小球滤过率 

分 类 号：R575.2[医药卫生—消化系统]