血清胱抑素C在多发性软组织挫伤患者急性肾损伤早期诊断中的应用

Serum cystatin C as an early diagnostic marker for AKI in adult patients with multiple soft tissue contusion

目的:探讨血清胱抑素C(CysC)对多发性软组织挫伤患者急性肾损伤(AKI)的早期诊断价值。方法:收集28例多发性软组织挫伤患者入院后不同时间的血、尿标本,选取其中AKI患者10例,分别测定CysC、血清肌酐(SCr)和计算的肾小球滤过率(eGFR);并选择临床资料相匹配的非AKI患者10例作对照。观察两组患者入院后CysC、SCr的动态变化。用受试者工作特征(ROC)曲线评价CysC诊断AKI的精确性。结果:两组临床指标差异均无统计学意义。AKI组患者CysC在入院后不同时间点显著升高。入院后10h取血CysC1.36为诊断截点,其在AKI诊断中的敏感度0.72,特异度0.93。结论:多发性软组织挫伤患者发生AKI时血CysC在不同时间点显著升高,诊断AKI的时间早于SCr,具有较高的准确性,可作为多发性软组织挫伤患者发生AKI的早期诊断标志物。

Objective ：To investigate the early prediction and diagnostic value of serum cystatin C （ CysC ） for acute kidney injury （AKI） in patients with adult multiple soft tissue contusion. Methodology：blood and urine samples of hospitalizing patients with adult multiple soft tissue contusion were prospectively collected. Ten cases of AKI were selected and their CysC, SCr and eGFR were measured ; 10 cases of non-AKI patients with similar clinical data were selected as control. Dynamic changes of CysC and SCr were monitored for both groups after admission. Receiver operating characteristic （ROC） curve was used to evaluate the accuracy of CysC-dependent diagnosis. AKI was defined as ≥50% increase of SCr level compared to baseline value. Results ： 20 cases had an average age of （ 29.0 ±8. 76 ） , and a baseline SCr level of （68. 9±21.5 ） mmol/L. The clinical indicators of the two groups had no significant difference. In AKI group, their urinary and blood biological markers were elevated at different time points after admission. When the blood CysC was measured 10hrs after hospitalization, and the diagnostic cut-off point at 1.36 was set,it would have sensitivity of 0. 72 and a specificity of 0. 93. Conclusion ： When AKI occurs in adult soft tissue contusion patients, the blood and urinary biomarkers will be significantly increased at different time points. This change is earlier than that of SCr and can be used for diagnosis of AKI with high accuracy. It can be used as an early diagnostic marker for AKI in adult muhiple soft tissue contusion patients.