血清胱抑素C在HBV相关慢加急性肝衰竭患者中的临床意义  

Clinical value of serum cystatin C measurements in patients with HBV related acute-on-chronic liver failure

作　　者：臧红[1] 郭建民 辛红霞 刘婉姝[1] 刘鸿凌[1] 朱冰[1] 刘振文[1] 谢国明[1] 胡燕[1] 辛绍杰[1] 游绍莉[1] Zang Hong Guo Jianmin Xin Hongxia Liu Wanshu Liu Hongling Zhu Bing Liu Zhengwen Xie Guoming Hu Yan Xin Shaojie You Shaoli(No. 302 Hospital of the People＇s Liberation Army of China,Beijing 100039, China （ Zang H, Liu WS, Liu HL, Zhu B, Liu ZW, Xie GM,Hu Y,Xin S J, You SL Yuanyang Center for Disease Control and Prevention, 453500 ,Henan province（ Guo JM, Xin HX)

机构地区：[1]解放军第三0二医院,北京100039 [2]河南省原阳县疾病预防控制中心,453500

出　　处：《中华实验和临床病毒学杂志》2017年第4期338-342,共5页Chinese Journal of Experimental and Clinical Virology

基　　金：国家“十二五”科技重大专项（2012ZX10002004-005）;国家“十三五”科技重大专项（2017ZX10203201-004）;军队“十二五”重点课题（BWS11J075）

摘　　要：目的 观察血清胱抑素C以及中性粒细胞明胶酶相关载脂蛋白（NGAL）、MMP-9/NGAL-1在HBV相关慢加急性肝衰竭（ACLF）并发AKI诊断中的意义.方法 以31例慢性乙型肝炎（Chronic hepatitis B,CHB）患者作对照,观察了102例HBV相关ACLF入院时以及AKI发生时血清胱抑素C以及中性粒细胞明胶酶相关载脂蛋白（NGAL）、MMP-9/NGAL-1的变化及其与AKI发生和预后的关系.结果 102例HBV相关ACLF患者血清胱抑素C水平明显高于CHB对照组（t=3.609,P=0.000）,而NGAL、MMP-9/NGAL-1水平ACLF组明显低于对照组（t=3.016,P=0.003;t=7.514,P =0.000）.102例ACLF患者中33例（32.4％）发生AKI.发生AKI患者血清胱抑素C水平明显高于非AKI组（t=4.543,P=0.000）,而MMP-9/NGAL-1和NGAL水平AKI与非AKI患者差异无统计学意义（t=0.905,P=0.368;t=0.061,P=0.952）.在AKI患者中血清肌酐〈1.5 mg/dl和SCr〉1.5mg/dl患者间血清胱抑素C水平均显著高于非AKI患者（P=0.022,0.000）.多因素分析结果表明,血清胱抑素C、TBIL、血钠以及肝性脑病、年龄是HBV相关ACLF患者AKI发生的独立危险因素.结论 血清胱抑素C水平对HBV相关ACLF并发AKI的早期诊断有重要意义,而NGAL、MMP-9/NGAL-1的变化可能与ACLF病情有关.Objective To study the clinical value of serum cystatin C,neutrophil gelatinaseassociated lipocalin （NGAL） and matrix metalloproteinase （MMP）-9/NGAL-1 measurements for early diagnosis of acute kidney injury （AKI） in patients with acute-on-chronic liver failure （ACLF）.Methods This study included 102 patients with hepatitis B virus related ACLF and 31 patients with chronic hepatitis B （CHB） were enrolled as controls.Biomarkers including serum cystatin C,NGAL and MMP-9/NGAL-1 were measured twice in the patients with ACLF at admission and at the time progressed to AKI and once in the controls.Results In patients with ACLF,serum cystatin C levels was higher than that of the CHB control （t =3.609,P =0.000）,whereas NGAL and MMP-9/NGAL-1 levels were lower in patients with ACLF than that of CHB controls （t =3.016,P =0.003;t =7.514,P =0.000,respectively）.Thirty-three patients （32.4%） progressed to AKI during hospitalization period.In AKI group of the patients serum cystatin C levels was higher than that of non-AKI group of the patents （t =4.543,P =0.000）.MMP-9/NGAL-1 and NGAL levels were not different in patients with and without AKI （t =0.905,P =0.368;t =0.061,P =0.952）.Serum cystatin C in patients with mild AKI （serum creatinine 〈 1.5 mg/dl） and AKI serum creatinine 〉 1.5 mg/dl were 33.59 ± 9.19 ng/ml and 43.32 ± 9.02 ng/ml respectively.That was higher than that of non-AKI patients （27.94 ± 7.93 ng/ml,P =0.022,0.000,respectively）.Serum cystatin C was the independent risk factors associated with development of AKI by a multivariate logistic regression in patients with ACLF.Conclusions Serum cystatin C measurement may contribute to more earlier diagnosis of AKI even in patients with S.creatinine 〈 1.5 mg/dl.NGAL and MMP-9/NGAL-1 may be the biomarker of progress for ACLF.

关 键 词：胱抑素C 急性肾损伤 肝功能衰竭 肝炎病毒 乙型 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]