血胱抑素C对缺氧缺血性脑病新生儿肾功能的诊断价值

Diagnostic value of serum cystatin C for renal function impairment in neonates with hypoxic-ischemic encephalopathy

目的探讨血胱抑素C(Cys C)对围生期缺氧缺血性脑病(HIE)新生儿肾功能损害的诊断价值。方法将入选新生儿分为两组:对照组25例、HIE组51例。后者又分为轻度HIE组(27例)和中-重度HIE组(24例)。测定患儿日龄3 d以内的血Cys C、血肌酐(SCr),并计算肌酐清除率(CCr),比较各组间各指标的差异。建立受试者工作曲线(ROC曲线),确定Cys-C及SCrROC曲线下的面积(AUC),同时分析不同截断值的敏感度、特异度、阳性和阴性预测值。结果(1)HIE组sCys C、SCr水平较对照组有显著升高;中-重度HIE组升高程度较轻度HIE组更显著,P<0.01。(2)sCys C和SCr在轻度HIE组的异常率分别为33.3%和25.9%,P>0.05;在中-重度HIE组的异常率为75.0%和45.8%,sCys C在HIE组的异常率高于SCr,但P>0.05,差异无统计学意义。(3)sCys C的AUC为0.831,SCr的AUC为0.928,两者差异无统计学意义(P>0.05)。结论测定sCysC水平作为监测窒息新生儿肾小球滤过率变化的指标,敏感度及准确度近似于SCr;用sCysC和SCr联合检测对临床肾功能的监测有重要意义。

Objective Cystatin C（Cys C） has been regarded as a sensitive marker of early renal function impairment.The purpose of this report is to evaluate the diagnostic value of serum Cys C for renal function impairment in neonates with hypoxic-ischemic encephalopathy（HIE）.Methods The serum Cys C concentrations were measured in 51 HIE newborn（27 cases were mild HIE and 24 cases were moderate-severe HIE） within 3 days after birth.25 cases had no perinatal asphyxia and other factors which can result in renal function impairment were served as control group.Compared serum Cys C（sCys C） with serum creatinine（SCr） and creatinine clearance rate（CCr） were calculated by Schwartz formula.The area under the receiver operating characteristic（ROC） and optimum sensitivity,specificity,predictive values were evaluated.Results （1） Compared with controls,the concentration of sCys C and SCr in HIE newborns had significant differences;The levels of sCys C and SCr in moderate-severe HIE newborns were significantly higher than that in mild HIE newborns,（P〈0.01）.（2） The area under ROC curve（AUC） were 0.831 for sCys,0.928 for SCr.The AUC had no statistically difference between sCys and SCr,P〉0.05.Conclusion SCys C appears to be equivalent in sensitivity and reliability to SCr for estimation of renal function in newborn.The combined measure of SCys C and SCr is important to monitoring the early change of glomerular filtration rate（GFR）.