血肌酐联合胱抑素C根据KDIGO标准诊断急性肾损伤  

Combined criteria of both serum cystatin c and creatinine for acute kidney injury based on KDIGO and its clinical implications

作　　者：张裕生[1] 陈源汉[2] 陈诗歆 李志莲[2] 吴燕华[2] 梁馨苓[2] 

机构地区：[1]广东省五华县人民医院内二科,514400 [2]广东省人民医院肾内科,广东省医学科学院,广州市510080 [3]广州医科大学公共卫生学院预防医学系,510182

出　　处：《实用医学杂志》2017年第21期3511-3513,共3页The Journal of Practical Medicine

基　　金：广东省科技计划协同创新与平台环境建设项目(编号:2017A070709008);广州市科技计划项目产学研协同创新重大专项(编号:201604020037);广东省卫生计生适宜技术推广项目资助项目(编号:2016200)

摘　　要：目的研究血肌酐联合胱抑素C诊断急性肾损伤(AKI)的临床价值。方法回顾性分析7 627例住院患者临床资料。根据全球肾脏病预后组织(KDIGO)标准分别用肌酐或胱抑素C判断有无AKI。结果最高血胱抑素C水平和肌酐值显著相关(Spearman相关系数0.699,P<0.001)。最高胱抑素C水平预测院内死亡的受试者工作特征曲线下面积0.761(95%可信区间0.693~0.828)。符合血肌酐和胱抑素C标准的AKI分别有1 004例(13.2%)和173例(2.3%)。血肌酐联合胱抑素C判断AKI,1 119例(14.7%)发生AKI。在多变量Logistic回归模型中,和血肌酐(-)胱抑素C(-)组比较,血肌酐(-)胱抑素(+)显著增加死亡的风险(OR值15.524,95%可信区间5.110~47.166)。结论联合胱抑素C能提高血肌酐诊断AKI的敏感性,有助于识别高危住院人群。Objective We aimed to investigate the clinical values of combination of blood creatinine andcystatin C for acute kidney injury(AKI)diagnosi. Methods Total 7 627 patients were studied retrospectively.The AKI was classified by creatinine or cystatin C according to the Kidney Disease:Improving Global Outcomescriteria. Results The maximum levels of cystatin C and creatinine were correlated(Spearman′s rank coefficient0.699,P < 0.001). The area under a receiver operating characteristic curve of maximum cystatin C value for pre-dicting in-hospital death was 0.761(95% confidence interval 0.693 ~ 0.828). Total 1 004 and 173 patients wereclassified into AKI by blood creatinine or by cystatin C(13.2% vs. 2.3%,P < 0.001),respectively. The total inci-dence of AKI was 14.7% diagnosed by the combination of the two markers. In multivariable logistic model,the cre-atinine negative plus cystatin C positive group was associated with a higher in-hospital death compared with the cre-atinine and cystatin C double negative group(OR 15.524,95% confidence interval 5.110 ~ 47.166,P < 0.001).Conclusion Combination of cystatin C increased sensitivity of creatinine for AKI diagnosis and facilitated to iden-tify in-hospital patients with high risk.

关 键 词：急性肾损伤 胱抑素C 住院死亡 全球肾脏病预后组织 诊断 

分 类 号：R692[医药卫生—泌尿科学]