血清胱抑素C对肝硬化患者并发急性肾损伤的诊断价值  

Diagnostic value of serum cystatin C for acute kidney injury in patients with liver cirrhosis

作　　者：蔡均均 周静[1] 韩涛[1] 张玉玲[1] 刘怀平[1] 付彦超[1] 

机构地区：[1]天津市第三中心医院肝内科天津市人工细胞重点实验室天津市肝胆疾病研究所,300170

出　　处：《中华肝脏病杂志》2017年第5期360-364,共5页Chinese Journal of Hepatology

基　　金：国家科技重大专项（2016ZX10002008-007）;天津市科委基金项目（12JCYBJC17300）

摘　　要：目的旨在探讨血清胱抑素C（CysC）诊断肝硬化患者急性肾损伤（AKI）的价值。方法采用颗粒增强免疫比浊法检测150例患者（其中肝硬化AKI患者88例，肝硬化非AKI患者62例）的血清CysC水平。应用受试者工作特征曲线评估血清CysC诊断肝硬化急性肾损伤的准确性。结果肝硬化AKI组患者血清CysC水平显著高于非AKI组，分别为2．37（1．75～2．83）蚍和0．97（0．85～1．09）mg／L，差异有统计学意义（Z=-10．236，P〈0．001）。血清CysC水平在急性肾小管坏死组患者最高，为5．41（2．77～6．19）mg／L，肝肾综合征组为2．55（2．28～3．59）mg／L和肾前性氮质血症组为2．07（1．70～2．41）mg／L，三组比较差异有统计学意义（χ2=23．217，P〈0．001）。此外，将AKI患者分为感染组和非感染组，感染组血清CysC水平显著高于非感染组，差异有统计学意义（Z=-2．509，P〈0．05）。血清CysC诊断肝硬化急性肾损伤的受试者工作特征曲线下面积为0．99（0．98～1．00），Cut-off值为1．36mg／L，其敏感度和特异度分别为97％和95％。结论血清CysC是检测肝硬化急性肾损伤的良好指标，其升高程度有助于区分不同的肾损伤类型。Objective To determine the diagnostic value of serum cystatin C （Cys C） for acute kidney injury （AKI） in patients with liver cirrhosis. Methods Serum Cys C levels in 150 liver cirrhosis patients （88 AKI and 62 non-AKI patients） were measured by the Particle-Enhanced Nephelometric Immuno-Assay. The accuracy of serum Cys C for the diagnosis of AKI in liver cirrhosis was evaluated by the ROC curve. Results Liver cirrhosis patients with AKI had significantly higher serum Cys C levels [2.37 （1.75-2.83） mg/L] than those without AKI [0.97 （0.85-1.09） g/L] （P 〈0.001）. Serum Cys C level was highest in the acute tubular necrosis group [5.41 （2.77-6.19） mg/L], followed by the hepatorenal syndrome group [2.55 （2.28-3.59） mg/L] and prerenal azotemia group [2.07 （1.70-2.41） mg/L], and the serum Cys C level was significantly different between the three groups （P 〈0.001）. In addition, patients with AKI were further divided into infection group and non-infection group. Serum Cys C level was significantly higher in the infection group than in the non-infection group （P 〈0.05）. The area under the ROC curve of serum Cys C for the diagnosis of AKI in liver cirrhosis was 0.99 （0.98-1.00） at a cut-off value of 1.36 mg/L, and the sensitivity and specificity were 97% and 95%, respectively. Conclusion Serum Cys C is a good marker for detecting AKI in liver cirrhosis, and the different levels of increase in Cys C may be useful in differentiating the different types of AKI.

关 键 词：肝硬化 肝肾综合征 肾小管坏死 急性 诊断 急性肾损伤 

分 类 号：R575.2[医药卫生—消化系统]