血肌酐、尿量及胱抑素C在病毒感染致儿童急性肾损伤中的诊断意义研究

The detection of serum creatinine, urine output, and urinary chalone C in children with acute kidney injury and its clinical significance

目的检测血肌酐（SCr）、尿量及胱抑素C（CysC）在病毒感染致儿童急性肾损伤（AKI）中的变化，并探讨其相关临床意义。方法收集危重型甲型H1N1流感病毒和肠道EV71病毒感染患儿34例，其中发生AKI12例（AKI组），其余22例患儿作为非AKI组。比较两组患儿入院时及入院后1、3d时SCr、尿量及CysC的差异。结果危重型甲型H1N1流感病毒和肠道EV71病毒感染患儿AKI发生率为35．3％（12／34）。两组入院时SCr及尿量比较差异无统计学意义（P〉0．05），但AKI组CysC显著高于非AKI组[（1．64±0．23）mg／L比（0．85±0．16）mg／L]（P〈0．05）。人院后非AKI组SCr、尿量及CysC变化差异无统计学意义（P〉0．05），但AKI组入院后1、3d时SCr及CysC水平显著高于入院时[（38．25±7．18）、（40．54±7．62）μmol／L比（25．26±5．42）μmol／L；（2．04±0．33）、（2．56±0．41）mg／L比（1．64±0．23）mg／L]（P〈0．05或P〈0．01），而尿量则显著减低[（0．37±0．12）、（0．41±0．14）ml／（kg·h）比（0．54±0．20）ml／（kg·h）]（P〈0．05）。AKI组SCr及尿量入院后1、3d时比较差异无统计学意义（P〉0．05），而CysC在人院后1、3d时比较差异有统计学意义（P〈0．01）。相关性分析显示血清CysC的表达与SCr呈显著正相关（r=0．412，P〈0．05），与尿量呈显著负相关（r=-0．364，P〈0．05）。结论病毒感染患儿中AKI发生率高，CysC在AKI早期诊断中的价值显著优于SCr和尿量，有望成为儿童AKI早期防治的临床检测指标。

Objective To detect the expression of serum creatinine （SCr）,urine output, and urinary chalone C （CysC） in children with acute kidney injury （AKI） and to explore its clinical significance. Methods A total of 34 children infected by H1N1 or EV71 virus were enrolled in this study. Thirty-four cases of children were divided into AKI group（ 12 cases） and non-AKI group（22 cases）. The level of SCr, urine output and CysC in two groups was compared on admission and 1,3 d after admission. Results The incidence rate of AKI in virus infected children was 35.3% （12/34）. There was no significant difference in SCr and urine output between two groups on admission （P 〉 0.05）. But the CysC in AKI group was higher than that in non-AKI group [ （ 1.64 ± 0.23 ） mg/L vs. （0.85 ± 0.16） mg/L ] （P 〈 0.05 ）. There was no significant difference of SCr, urine output and CysC in non-AKI group （P 〉 0.05 ）, but the level of SCr and CysC in AKI group after admission was significantly higher than that on admission [（38.25 ± 7.18）, （40.54± 7.62） μ mol/L vs. （25.26 ± 5.42）μ mol/L; （2.04 ± 0.33 ）, （2.56 ± 0,41 ） mg/L vs. （ 1.64± 0.23 ） mg/L ] （P 〈 0.05 or 〈 0.01 ）, and urine output was significantly lower[ （0.37 ± 0.12）, （0.41 ± 0.14） ml/（kg.h） vs. （0.54 ±0.20） ml/ （kg. h） ] （P 〈 0.05 ）. There was no significant difference in AKI group in SCr and urine between 1 day and 3 day after admission, while the CysC was statistically significant （P 〈 0.01 ）. Correlation analysis showed that the expression of serum CysC and SCr had positively significant correlation （r = 0.412,P 〈 0.05）, and the urine volume had significantly negative correlation （r =-0.364, P 〈 0.05 ）. Conehtsions High incidence of AKI occurs in children of virus infection. CysC value in early diagnosis of AKI is significantly superior to SCr and urine volume, and is expected to be an index in early prevention and treatment of children with AKI.