血清半胱氨酸蛋白酶抑制剂C对急性胰腺炎肾功能损伤的早期诊断价值

The early diagnostic value of serum cystatin C for detecting renal dysfunction in patients with acute pancreatitis

目的:探讨血清半胱氨酸蛋白酶抑制剂C(CysC)检测对急性胰腺炎(AP)患者肾功能损害早期诊断的意义。方法:测定72例急性胰腺炎患者的24h肌酐清除率(Ccr),血清肌酐(SCr),以及血清CysC水平,并以CCr<80mL/(min·1.73m2)作为肾功能损害诊断标准,采用χ2检验,相关性分析和ROC曲线分析了解CysC的诊断价值。结果:72例患者中共有28例出现CCr下降,在这28例患者中,CysC水平上升的有23例,而SCr出现异常的仅有16例,χ2检验分析后提示CysC对CCr的评估效能优于SCr(P<0.05)。相关性分析提示AP患者中,CysC与SCr均和CCr有着显著的负相关性(CysC:r=-0.868,P<0.001;SCr:r=-0.604,P<0.001),而CysC的相关系数较高。ROC曲线分析显示CysC的曲线下面积(AUC)值明显高于SCr(0.884vs0.687)。结论:CysC较SCr能更为准确和早期发现AP患者急性肾功能损害,常规监测AP患者的CysC水平,对有效治疗AP和预防急性肾功能衰竭的发生具有积极意义。

Objective To investigate the early diagnostic value of serum cystatin C for detecting renal dysfunction in patients with acute pancreatitis （AP）. Methods 24-hour creatinine clearance （CCr） and serum levels of cystatin C （Cys C） and creatinine （SCr） were measured in 72 patients. The diagnostic value of Cys C was evaluated by 2 test, Pearson correlation test, and ROC curve. Results CCr declined in 28 out of 72 AP patients. Of these 28 patients, 23 had an increased level of Cys C, whereas 16 had an elevation in SCr level. The evaluating efficiency of Cys C for CCr was superior to that for SCr （P 〈 0.05）. Both Cys C and SCr significantly inversely correlated with CCr （CysC： r = -0.868,P 〈 0.001; SCr： r = -0.604, P 〈 0.001 ）; however, coefficient of Cyst C to CCr was obviously higher than that of SCr, ROC curve showed cystatin C was diagnostically superior to creatinine （area under the curve [AUC] for cystatin C 0.884; AUC for creatinine 0.687）. Conclusions Cystatin C, as compared with SCr, is a more accurate, sensitive marker for renal dysfunction in AP. Routine detection of Cys C level in AP patient play an active role in effectively preventing and treating acute renal failure in patients with acute pancreatitis.