血胱抑素C等对肺癌患者化疗过程中肾损伤的评价

Evaluation of serum cystatin C in kidney function damage for patients with lung cancer during chemotherapy

目的:评价血清胱抑素C(CysC)、肌酐(Cr)、尿素(urea)、β2-微球蛋白(β2-MG)在肺癌患者化疗期间肾损伤中的意义。方法:收集443例肺癌并接受化疗的患者,检测血Cr,urea,β2-MG,CysC的浓度水平;同时测定^(99)Tc^m-DTPA的清除率(rGFR)作为评价肾功能的金标准。分析不同化疗周期中各指标的变化,并将血Cr,urea,β2-MG,CysC与rGFR加以比较。结果:在化疗过程中,血CysC较其他3个指标能更早地发现肾功能的受损情况,在化疗1周期后就有明显升高(P<0.05);任何化疗周期,CysC都与rGFR相关性最高;在各肾功能分期,CysC的异常检出率均最高;CysC诊断准确度,Youden指数和受试者工作曲线下面积(AUC)均最高,且CysC敏感性最高。结论:血清CysC是评价肺癌患者化疗期间肾功能损害的最敏感、可靠的指标。

Objective： To evaluate the significance of serum cystatin C （CysC）, creatinine （Cr）, urea and β2 microglobulin （β2-MG） in kidney function damage for patients with lung cancer during chemotherapy. Methods： Concentrations of Cr, urea, β2-MG, CysC were tested among 443 patients with lung cancer, meanwhile clearance of ^99Tc^m-DTPA （rGFR） was detected as gold standard of renal function. The index changes in different cycles of chemotherapy were analyzed and compared with rGFR. Results： CysC detected renal injury earlier than the other three, and were increased significantly after 1 cycle of chemotherapy; CysC was the most highly correlated with rGFR in different cycles of chemotherapy; rates of abnormal of CysC was the highest in every GFR stage; and the highest diagnostic accuracy, Youden index, area under ROC curve and sensitivity were all obtained from CysC. Conclusion： Serum CysC may be the most sensitive and reliable index to evaluate of renal injury during chemotherapy in patients with lung cancer.