血清半胱氨酸蛋白酶抑制剂C对肝脏切除术患者术后肾功能监测的临床价值

Clinical value of serum Cystatin C for detection of renal function in patient after liver resection

目的探讨血清半胱氨酸蛋白酶抑制剂C(Cystatin C,Cys C)监测对肝脏手术后患者肾功能水平的临床价值。方法测定141例肝脏手术患者术后的24 h肌酐清除率(24 hccr)、血清肌酐(SCr)以及血清CystatinC(Cys C)水平,并以CCr<80 mL/min/1.73 m2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Cys C的诊断价值。结果 141例患者中共有32例出现CCr下降,在这32例患者中,CysC水平上升的有28例,而SCr出现异常的仅有15例,χ2检验分析后提示CysC对CCr的评估效能优于SCr(P<0.05)。相关性分析提示在该类患者中,Cys C与SCr均和CCr有着显著的负相关性(CysC:r=-0.742,P<0.001;SCr:r=-0.503,P<0.001),而Cys C的相关系数较高。ROC曲线分析显示Cys C的曲线下面积(AUC)值明显高于SCr(0.815 vs 0.643)。结论 Cys C较SCr能更为准确反映肝脏手术患者术后的肾功能损害,常规监测该类患者的Cys C水平,对有效预防该类患者术后肾功能不全,减少肝肾综合征的发生率具有积极意义。

Objective To investigate the clinical value of serum Cystatin C（Cys C） for monitoring of renal function in patient after liver resection.Methods 24-hours creatinine clearance（CCr）,serum level of Cys C and serum creatinine（SCr） were measured in 141 patients after liver resection.x2 test,Pearson correlation test and ROC curve were utilized to evaluate the diagnostic significance of Cys C.Results Thirty-two out of 141 patients suffered the renal injury.Among these 32 patients,level of Cys C increased in 28 cases,whereas the elevation of SCr level in 15 cases were turn out.Cys C and SCr both significantly inversely correlated with CCr（CysC： r=-0.742,P0.001;SCr： r=-0.503,P0.001）.However,coefficient of Cyst C to CCr was obviously higher than that of SCr.Moreover,using ROC curve,Cystatin C was diagnostically superior to SCr（area under the curve for cystatin C 0.815,AUC for creatinine 0.643）.Conclusion Cys C is a more accurate marker of renal injury in patients after liver resection.Detection of Cys C level in these patients can contribute the prevention of renal injury or hepatorenal syndrome.