胱抑素C对体外循环术后急性肾损伤的早期预测价值的研究  

Study on the early predictive value of cystatin C in acute kidney injury after cardiopulmonary bypass

作　　者：董佳月 倪红英[1] 

机构地区：[1]浙江省金华市中心医院重症医学科(ICU),浙江金华321000

出　　处：《中国现代医生》2017年第25期4-7,169,共5页China Modern Doctor

基　　金：浙江省金华市科学技术局资助项目(2013-3-008)

摘　　要：目的探讨Cys C在体外循环术后患者急性肾损伤早期诊断中的价值。方法选择我院重症监护室2013年7月~2016年10月行体外循环术后患者114例,根据术后有无产生急性肾损伤分为观察组及对照组,测定术后第1、2、3、4天Cys C数值,采用ROC曲线评价Cys C对体外循环术后急性肾损伤的诊断价值。结果结果显示,观察组Cys C_1、Cys C_2、Cys C_3、Cys C_4(术后第1、2、3、4天Cys C数值)、Cys C_x(术后Cys C平均值)及Cys C_(nl)(Cys C标准负荷量)与对照组比较,有统计学差异(P_1=0.006,P_2=0.022,P_3=0.001,P_4=0.000,P_x=0.000,P_(nl)=0.005),ROC曲线结果显示,Cys C_1的ROC曲线下面积为0.674,Cys C_2的ROC曲线下面积为0.672,Cys C_3的ROC曲线下面积为0.706,Cys C_4的ROC曲线下面积为0.752,Cys C_x的ROC曲线下面积为0.732,Cys C_(nl)的ROC曲线下面积为0.702,采用Cys C_1为早期诊断指标,Cys C_1的最佳截断值为1.3 mg/L;多次测量的患者可采用Cys C_(nl)作为早期诊断指标,Cys C_(nl)的最佳截断值为1.15 mg/L。结论 Cys C可作为体外循环术后患者发生急性肾损伤的内源性标志物,Cys C_1及Cys C_(nl)可作为体外循环术后急性肾损伤早期诊断的指标。Objective To evaluate the value of Cys C in the early diagnosis of acute kidney injury after cardiopulmonary bypass. Methods A total of 114 patients who underwent cardiopulmonary bypass from July 2013 to October 2016 in the ICU in our hospital were selected. According to whether there was the occurrence of acute kidney injury after surgery,the patients were divided into observation group and control group. The value of Cys C was measured at 1, 2, 3 and 4days after operation. The diagnostic value of Cys C in acute kidney injury after cardiopulmonary bypass was evaluated by ROC curve. Results The results showed that there were statistical differences in Cys C_1, Cys C_2, Cys C_3, Cys C_4(Cys C values on day 1, 2, 3 and 4 days after the surgery), Cys C_x(mean value of Cys C after the surgery) and Cys C_(nl)(Cys C standard load) between the observation group and the control group(P_1=0.006, P_2=0.022, P_3=0.001, P_4=0.000, P_x=0.000,P_(nl)=0.005). The ROC curve showed that the area under the ROC curve of Cys C_1 was 0.674, the area under the ROC curve of Cys C_2 was 0.672, that of Cys C_3 was 0.706, that of Cys C_4 was 0.752, that of Cys C_xwas 0.732, and that of Cys C_(nl)was 0.702. Cys C_1 was used as the early diagnosis index. The optimal cutoff value of Cys C_1 was 1.3 mg/L; Cys C_(nl) could be used as an early diagnostic index for the patients with multiple measurements. The optimal cutoff value for Cys C_(nl)was 1.15 mg/L. Conclusion Cys C can be used as an endogenous marker of acute kidney injury in patients after cardiopulmonary bypass. Cys C_1 and Cys C_(nl)can be used as an early diagnosis index of acute kidney injury after cardiopulmonary bypass.

关 键 词：重症监护室 胱抑素C 体外循环 急性肾损伤 早期诊断 

分 类 号：R654.2[医药卫生—外科学]