血清胱抑素C预测神经重症患者急性肾损伤的临床价值  

Clinical value of serum Cystatin C in predicting acute kidney injury in critically neurological patients

作　　者：池锐彬[1] 梁美华[1] 罗醒政[1] 刘力新[1] 邓宇珺[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

出　　处：《临床急诊杂志》2016年第11期837-840,共4页Journal of Clinical Emergency

基　　金：中山市科技攻关医学计划项目(No:2016B1083)

摘　　要：目的:探讨血清胱抑素C(sCysC)预测神经重症患者发生急性肾损伤(acute kidney injury,AKI)临床价值。方法:前瞻性入选2015-03-2015-12入住南方医科大学附属小榄医院重症医学科(ICU)的110例神经重症患者。以KDIGO标准为诊断标准,将患者分为非AKI组和AKI组,比较各组患者sCysC及血肌酐(sCr)水平。运用受试者工作特征(ROC)曲线及曲线下面积(AUC)评价sCysC对AKI的诊断和短期预后的预测价值。结果:110例患者中有39例发生AKI,AKI发生率为35.5%。AKI组患者sCysC水平明显高于非AKI组,差异有统计学意义(P<0.05)。sCysC预测AKI和重症AKI的AUC分别为0.946和0.936,预测肾脏替代治疗的AUC为0.952。本研究队列中,住院死亡率为12.7%,肾脏替代治疗率为4.5%,AKI组的住院死亡率及肾脏替代治疗率均明显高于非AKI组(均P<0.05)。结论:sCysC是预测神经重症患者发生AKI及预后的可靠指标,并且提供判断患者短期预后的相关信息。Objective：To explore the clinical value of serum cystatin C （sCysC） in predicting acute kidney injury（AKI） in critically neurological patients. Method：In this study, we prospectively enrolled 110 adult critically neurological patients who had been admitted to the mixed ICU of Xiaolan Hospital of Southern Medical University during March 2015 to December 2015. According to the Kidney Disease Improving Global Outcomes （KDIGO） criterion,the patients were divided into non-AKI group and AKI group. We evaluated its capability of detecting AKI and its prognosis by using the receiver operating characteristic（ROC） curve and the area under curve（AUC）. Resuit：We found AKI in 39 patients （35.5 %）. The level of sCysC was significantly higher in AKI than in non-AKI （P〈0.05）. sCysC was able to distinguish AKI from non-AKI with an area under the receiver operating characteristic curve （AUC-ROC） of 0. 946. And sCysC were able to predict severe AKI and renal replacement with AUC value of 0. 936 and 0. 952 respectively. In this cohort,in-hospital mortality was 12.7% and renal replacement therapy rate was 4.5 %, which were strikingly higher in AKI group than nor. AKI group（P〈0.05）. Conclusion： sCysC is a reliable index for predicting diagnosis of AKI in critically neurological patients,and provide useful information about short-term prognosis.

关 键 词：神经重症 急性肾损伤 胱抑素C 诊断与预后 

分 类 号：R692[医药卫生—泌尿科学]