乙型肝炎肝硬化并发肾损害的危险因素及胱抑素C在诊断中的价值  

The risk factors of hepatitis B cirrhosis complicated by renal damage and the significance of Cystatin C in its diagnosis

作　　者：阎双缓 YAN Shuanghuan(The Fifth Hospital of Shijiazhuang City,Hebei,Shijiazhuang 050000,China)

机构地区：[1]河北省石家庄第五医院

出　　处：《河北医药》2019年第23期3595-3598,共4页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题(编号:20181077)

摘　　要：目的了解乙型肝炎肝硬化并发肾损害的危险因素及胱抑素C在诊断中的价值。方法选取2016年1月至2017年12月住院治疗的乙型肝炎肝硬化患者258例,收集患者一般资料,记录患者入院时肝功能及肾功能(血肌酐、血尿素氮及血清胱抑素C)。结果所有入组乙肝肝硬化患者eGFR均值为(99.85±32.82)ml/min/1.73 m^2,Cys C检测均值为(3.39±0.96)mg/L,呈显著负相关(r=-0.472,P<0.05)。所有入组乙肝肝硬化患者CysC、eGFR异常率比较,差异有统计学意义(χ^2=4.001,P<0.05)。以Child-Pugh分级分组分析CysC测定结果表中显示血CysC值,C组>B组>A组,差异有统计学意义(F=4.69,P<0.01)。Logistic回归分析提示年龄、高血压病、糖尿病、高尿酸血症、造影剂应用史、Child分级均与肾功能受损相关,其中年龄、高尿酸血症、造影剂应用史、Child分级均与肾损伤独立相关,而性别、HBV DNA定量、HBeAg状态与肾损伤无关。结论CysC水平在反映乙型肝炎肝硬化并发肾功能损伤方面敏感性较好、特异性较强,是反映肾小球滤过功能受损的可靠指标。乙型肝炎肝硬化患者中高龄、合并高尿酸血症、既往应用造影剂者、Child-Pugh分级高的患者为肾损伤的高危人群,应高度警惕肾功能受损的发生。Objective To investigate the risk factors of hepatitis B cirrhosis complicated by renal damage and the significance of Cystatin(CysC)in its diagnosis.Methods A total of 258 patients with hepatitis B cirrhosis who were treated in our hospital from January 2016 to December 2017 were enrolled in the study.The general information of the patients was collected,and the liver function and renal function indexes including serum creatinine,blood urea nitrogen and serum CysC were detected and analyzed.Results The average eGFR of all the patients was(99.85±32.82)ml/min/1.73m^2,the mean value of CysC was(3.39±0.96)mg/L.The correlation analysis showed a significant negative correlation between CysC and eGFR in patitents with hepatitis B cirrhosis(r=0.472,P<0.05).There was significant difference in the abnormality rate of CysC and eGFR(P<0.05).Child-Pugh grading showed that the positive rate of CysC in group C was significantly higher than that in group B,which in groupB was significantly higher than that in group A(P<0.01).Logistic regression analysis showed that patient’s age,hypertension,diabetes,hyperuricemia,history of contrast media application and Child grade were related to impairment of renal function,in which,patient’s age,hyperuricemia,history of contrast agent application and Child grade were independently related to impaired renal function,however,patient’s sex,HBV DNA quantification and HBeAg positive rate were not related to impaired renal function.Conclusion The CysC levels are sensitive and specific indexes of reflecting impaired renal function of patients with hepatitis B cirrhosis,which are also reliable indexes of reflecting impaired renal function of patients.In the patients with hepatitis B cirrhosis,patient’s age,hyperuricemia,history of contrast agent application and higher grade of Child-Pugh are the high risk population of impaired renal function,it should be paid much atttention to the occurrence of impairment of renal function.

关 键 词：乙型肝炎肝硬化 肾损害 危险因素 胱抑素C 

分 类 号：R657.31[医药卫生—外科学]