胱抑素C在肾部分切除术后急性肾损伤的早期诊断应用价值

The application value of cystatin C in the early diagnosis of acute kidney injury after partial nephrectomy

目的探讨胱抑素C（CysC）在肾部分切除术（PN）后急性肾损伤（AKI）的早期诊断应用价值。方法将98例接受肾部分切除术的肾癌患者根据急性肾损伤定义（术后48h内血清肌酐水平比基础值上升至少50％定义为AKI），入组患者分为急性肾损伤组（AKI group）作为观察组31例和非急性肾损伤组（no AKI group）作为对照组67例。结果观察组的术中液体负平衡量显著地少于对照组[（509．24±45．31）ml vs．（1105．38±138．25）ml]（P〈0．05），而手术时间及输血量与对照组比较差异有统计学意义（P〈0．05），观察组的HR、MAP与对照组比较差异无统计学意义（P〉0．05），而观察组平均尿量显著地少于对照组[（57．56±9．73）ml／hVS．（90．88±11．76）ml／h]（P〈0．05），两组术后6h尿素氮、B2MG、MALB比较差异无统计学意义（P〉0．05），观察组术后6h CysC显著地高于对照组[（1．28±0．19）mg／LV8．（0．88±0．09）mg／L]（P〈0．05），术后24h CysC浓度预测AKI敏感性为0．708，特异性为0．712，其阈值为0．965mg／L，术后6h CysC对AKI的预测价值优于术中液体负平衡量和术后6h平均尿量（P=0．00）。结论术后血清胱抑素C是预测肾部分切除术后急性肾损伤的良好指标。

Objective To explore the application value of cystatin C （CysC） in the early diagnosis of acute kidney injury （AKI） after partial nephrectomy （PN）. Method 98 patients with kidney cancer who underwent PN were divided into AKI group （observation group, 31 cases） and no AKI group （control group, 67 cases） according to the definition of AKI （serum creatinine level rises at least 50% than the base value within postoperative 48 h is defined as AKI）. ResuRs The intraoperative amount of negative fluid balance in observation group was significantly less than that in control group [（509.24±45.31）ml vs.（1 105.38± 138.25 ）ml, P〈0.05 ], there were statistically significant differences in the operation time and blood transfusion volume between observation group and control group （P〈0.05）, there were no statistically significant differences in HR, MAP between two groups （P〉0.05）, the urine volume in observation group was significantly less than that in control group [（57.56±9.73） ml/h vs.（90.88±11.76）ml/h, P〈0.05], there were no statistically significant differences in urea nitrogen,β2MG, MALB between two groups （P〉0.05）, CysC at postoperative 6 h in observation group was significantly higher than that in control group [（1.28±0.19）mg/L vs.（0.88±0.09）mg/L,P〈0.05], the sensitivity of CysC concentration at postoperative 24 h in the prediction of AKI was 0.708, the specificity was 0.712, the threshold was 0.965 mg/L, the predictive value of CysC at postoperative 6 h for AKI was better than those of intraoperative amount of negative fluid balance and average urine volume at postoperative 6 h （P=0.00）. Conclusion Postoperative serum cystatin C is a good indicator in the prediction of acute kidney injury after partial nephrectomy.