血清半胱氨酸蛋白抑制剂C与急性肾衰竭预后关系的研究

Prospective study for prognostic value of serum cystatin C in acute renal failure

目的:探讨急性肾衰竭(ARF)时血清半胱氨酸蛋白酶抑制剂C(CysC)水平变化及其与预后的关系。方法:前瞻性收集本院重症监护室215例危重病人,每天采血检测血肌酐(Scr)和CysC水平,应用Cockroft-Gault公式估算肾小球滤过率(GFR),ARF按ADQI的RIFLE标准进行分层诊断。结果:41例病人发生不同程度ARF,R标准7例、I标准13例,F、L和E标准共21例;死亡21例,存活20例;174例非ARF病人作为对照组。ARF病人血清CysC水平明显高于对照组病人(P<0.01);在ARF的不同RIFLE分层标准中,血清CysC与Scr、[CysC]-1与GFR呈显著线性相关(P<0.01);当以Scr升高≥150%作为ARF的诊断标准时,ROC分析显示血清CysC在ARF的诊断上准确性高,曲线下面积为(AUC):0.983(95%可信区间0.960-1.006)(P<0.01)。Logistic回归分析显示血清CysC和Scr与ARF病人死亡率无关(P>0.05);ROC分析表明CysC和Scr不能预测ARF病人的死亡和存活情况(P>0.05)。结论:血CysC在ARF时明显升高并与ARF的严重程度密切相关;CysC可以作为ARF的检测手段之一,但与病人的预后无关不能作为病人预后的预测指标。

AIM： To study the level of serum cystatin C （Cys C） and its prognostic value in acute renal failure （ARF）. METHODS： 215 critically ill patients were studied prospectively, and each blood sample was determined daily. Serum creatinine （Ser） was measured by enzymic method. Cys C was detected by particle- enhanced turbidimetric immunoassay （PEUA） and glomerular filtration rate （GFR） was estimated by Cockroft- Gauh equation. ARF was diagnosed according to ADQI （RIFLE） criteria. RESULTS： 41 patients developed ARF to some degree, among which 7, 13 and 21 patients fulfilled R- , Ⅰ- , and FLE - criteria, respectively. 21 were death and 20 survival in total 41 ARF patients. 174 patients without ARF served as controls. In patients with ARF, Cys C was significandy increased than that in patients who did not develop ARF （P 〈 0.01）. In different RIFLE criteria of ARF, serum Cys C was linearly con＇elated with serum creatinine （P〈0.01）, also [Cys C]^-1 with estimated GFR （ P 〈 0.01 ）. When ARF was diagnosed according to serum creafinine increased ≥ 150%, serum Cys C was demonstrated a highly diagnostic value to detect ARF as indicated by area under the curve （AUC） of the ROC curve of 0.983 （95% confidence interval, 0.960- 1.006） （P 〈 0.01 ）. Logistic regression showed serum Cys C and Ser were not independently risk factors for the mortality of ARF （ P 〉 0.05）. Also ROC analysis demonstrated serum Cys C and Ser had no predicting value of the fatality and survival in ARF （ P 〉 0.05 ）. CONCLUSION： Serum Cys C is significantly increased in ARF and con-elated well with the severity of ARF. Serum Cys C can be one of the detectable markers of ARF, but it is independent of the mortality and does not predict the prognosis of these patients.