Cys C在中高危心脏手术后急性肾损伤早期诊断中的价值

The value of Cys C in early diagnosing acute kidney injury after high risk cardiac surgery

目的评价半胱氨酸蛋白酶抑制剂C(Cys C)在中高危心脏手术后急性肾损伤早期诊断中的价值。方法前瞻性选取2014年1月-2016年9月于本院接受心脏手术的中高危患者235例,根据术后是否发生急性肾损伤(AKI)分为AKI组(A组,34例)与对照组(C组,201例),比较2组患者围术期血清尿素、肌酐、尿酸及Cys C水平,观察上述指标在各时点的动态变化。结果 AKI组患者体重较重,体外循环时间与主动脉阻断时间均长于对照组(P<0.05),并且术后死亡率(41.18%)明显高于对照组(3.48%)。术前两组患者尿素、肌酐及尿酸水平比较无统计学差异,但Cys C水平,AKI组高于对照组(P<0.05);术后各时点两组比较,AKI组各项指标均高于对照组(P<0.05)。结论对于中高危心脏手术患者,肥胖与长时间体外循环可能是术后发生AKI的危险因素,因予以重视。术前血清Cys C水平高于1.22 mg/L即超过正常水平上限的患者,术后易发生AKI,应及早采取有效治疗措施,防止肾功能进一步损伤。术后连续监测血清尿素、肌酐、尿酸及Cys C水平对于早期诊断AKI具有重要的价值。

Objective To assess the value of Cystatin C（Cys C）in early diagnosing of postoperative acute kidney injury（AKI）after high risk cardiac surgery. Methods 235 middle-high risk patients undergoing cardiac surgery in our hospital from January 2014 to September 2016 were enrolled in the study. According to whether postoperative AKI were occurred,patients were divided into 2 groups：AKI group（A group,n=34）and control group（C group,n=201）. The level of perioperative serum urea,creatinine,uric acid and Cys C between two groups were compared,and the dynamic changes of above indicators at each point were observed. Results Patients from AKI group were more weighty,and extracorporeal circulation time and aorta blocking time were longer than those in the control group（P0.05）;The postoperative mortality of AKI group（41.18%）was obviously higher than that of the control group（3.48%）. There were no significant difference between two groups at the level of preoperative serum urea,creatinine and uric acid,but the level of Cys C in AKI group were higher than that in the control group（P 0.05）;The levels of all postoperative indicators in AKI group were higher than those in control group（P0.05）. Conclusion Obesity and extracorporeal circulation for a long time may be risk factors of postoperative AKI.Aas for middle-high risk patients undergoing cardiac surgery,whose preoperative serum Cys C level higher than 1.22 mg/L or close to normal limit,areis more likely to suffer postoperative AKI,and they should be taken more attention and used effective treatment to prevent further injury of renal function. Continuous monitoring of the postoperative serum urea,creatinine,uric acid and Cys C level are very important for early diagnosis of AKI.