血清半胱氨酸蛋白酶抑制剂C与肾脏病理改变的相关性分析

Correlation analysis on kidney pathological changes with serum cystatin C

目的通过探讨半胱氨酸蛋白酶抑制剂C(Cys C)、血清肌酐(SCr)与一些重要肾脏病理改变及临床指标的相关性,为Cys C的临床应用提供更多的循证医学证据。方法随机抽取260例肾活检患者,分别分析患者的Cys C、SCr与肾脏病理损害程度(全球硬化、肾小管萎缩、间质纤维化)评分、年龄、血红蛋白(Hb)的相关性。将患者按全球硬化0～4分划分为5组;按肾小管萎缩0～3分划分为4组;按间质纤维化0～3分划分为4组,再分别比较各病理组间Cys C及SCr的变化。结果 Cys C与SCr、全球硬化、肾小管萎缩、间质纤维化、年龄均呈明显正相关(r分别为0.850、0.471、0.592、0.610、0.197,P均<0.01);SCr与全球硬化、肾小管萎缩、间质纤维化均呈明显正相关(r分别为0.501、0.595、0.607,P均<0.01),但SCr与年龄无相关性(r=0.118,P>0.05);Cys C、SCr均与Hb呈明显负相关(r分别为-0.448、-0.369,P均<0.01)。各病理组间Cys C及SCr水平差异均有统计学意义(P均<0.01),随着病理损害程度的增加,各组Cys C及SCr水平也随之增加;当病理损害程度达到1～2分(<50%)时,大多数患者Cys C水平达到或超出参考范围上限,而大多数患者SCr水平仍在参考范围内。结论 Cys C与SCr均能较好地反映患者的肾脏病理损害及肾功能状况,Cys C评价早期肾损伤的敏感性要优于SCr,但两者均存在影响因素。因此在选择评估肾功能的指标时应以患者存在的影响因素为参考,必要时可联合多项指标以提高评估肾功能的准确性。

Objective To investigate the correlations of the serum cystatin C （Cys C）, serum creatinine （SCr）, some important kidney pathological changes and clinical indices, and to provide more reference for the clinical application of Cys C. Methods A total of 260 patients with kidney biopsy were enrolled randomly. The correlations of Cys C, SCr and kidney disease severity （global sclerosis, renal tubular atrophy and interstitial fibrosis） score, age and hemoglobin （Hb） were analyzed. The patients were classified into 5 groups according to the global sclerosis 0 -4 points, were classified into 4 groups according to the renal tubular atrophy 0 - 3 points, and were classified into 4 groups according to the interstitial fibrosis 0 -3 points. The Cys C and SCr changes were compared among the various pathological groups. Results Cys C with SCr, global sclerosis, renal tubular atrophy, interstitial fibrosis and age showed a significant positive correlation（r =0. 850,0. 471,0.592,0. 610 and 0. 197, P 〈0. 01 ）, and SCr with global sclerosis, renal tubular atrophy and interstitial fibrosis showed a significant positive correlation （r = 0. 501,0. 595 and 0.607,P 〈 0.01 ）, but there was no correlation between SCr and age （r = 0.118, P 〉 0.05）. Cys C and SCr had a significant negative correlation with Hb （ r = - 0.448 and - 0.369, P 〈 0.01 ）. The differences of Cys C and SCr among the various pathological groups were statistically significant （ P 〈 0.01 ）. With the increasing of pathological damage degrees, the Cys C and SCr levels also increased, but when pathological damage degrees reached 1-2 points （ 〈 50% ）, the Cys C level of most patients reached or exceeded the upper limit of the reference range, however the SCr levels of most patients were still in the reference range. Conclusions Cys C and SCr can reflect the kidney pathological damage and renal functional status of patients. Cys C is superior to SCr in the sensitivity of evaluating early renal injury. However, both of them have influence factors. When choosing the indices for evaluating kidney function, the influence factors of patients should be considered for reference, then when necessary, they can be associated with several indices to improve the accuracy of evaluating kidney function.