血清胱抑素C在HBV相关慢加急性肝衰竭患者中的临床意义

Clinical value of serum cystatin C measurements in patients with HBV related acute-on-chronic liver failure

目的 观察血清胱抑素C以及中性粒细胞明胶酶相关载脂蛋白（NGAL）、MMP-9/NGAL-1在HBV相关慢加急性肝衰竭（ACLF）并发AKI诊断中的意义.方法 以31例慢性乙型肝炎（Chronic hepatitis B,CHB）患者作对照,观察了102例HBV相关ACLF入院时以及AKI发生时血清胱抑素C以及中性粒细胞明胶酶相关载脂蛋白（NGAL）、MMP-9/NGAL-1的变化及其与AKI发生和预后的关系.结果 102例HBV相关ACLF患者血清胱抑素C水平明显高于CHB对照组（t=3.609,P=0.000）,而NGAL、MMP-9/NGAL-1水平ACLF组明显低于对照组（t=3.016,P=0.003;t=7.514,P =0.000）.102例ACLF患者中33例（32.4％）发生AKI.发生AKI患者血清胱抑素C水平明显高于非AKI组（t=4.543,P=0.000）,而MMP-9/NGAL-1和NGAL水平AKI与非AKI患者差异无统计学意义（t=0.905,P=0.368;t=0.061,P=0.952）.在AKI患者中血清肌酐〈1.5 mg/dl和SCr〉1.5mg/dl患者间血清胱抑素C水平均显著高于非AKI患者（P=0.022,0.000）.多因素分析结果表明,血清胱抑素C、TBIL、血钠以及肝性脑病、年龄是HBV相关ACLF患者AKI发生的独立危险因素.结论 血清胱抑素C水平对HBV相关ACLF并发AKI的早期诊断有重要意义,而NGAL、MMP-9/NGAL-1的变化可能与ACLF病情有关.

Objective To study the clinical value of serum cystatin C,neutrophil gelatinaseassociated lipocalin （NGAL） and matrix metalloproteinase （MMP）-9/NGAL-1 measurements for early diagnosis of acute kidney injury （AKI） in patients with acute-on-chronic liver failure （ACLF）.Methods This study included 102 patients with hepatitis B virus related ACLF and 31 patients with chronic hepatitis B （CHB） were enrolled as controls.Biomarkers including serum cystatin C,NGAL and MMP-9/NGAL-1 were measured twice in the patients with ACLF at admission and at the time progressed to AKI and once in the controls.Results In patients with ACLF,serum cystatin C levels was higher than that of the CHB control （t =3.609,P =0.000）,whereas NGAL and MMP-9/NGAL-1 levels were lower in patients with ACLF than that of CHB controls （t =3.016,P =0.003;t =7.514,P =0.000,respectively）.Thirty-three patients （32.4%） progressed to AKI during hospitalization period.In AKI group of the patients serum cystatin C levels was higher than that of non-AKI group of the patents （t =4.543,P =0.000）.MMP-9/NGAL-1 and NGAL levels were not different in patients with and without AKI （t =0.905,P =0.368;t =0.061,P =0.952）.Serum cystatin C in patients with mild AKI （serum creatinine 〈 1.5 mg/dl） and AKI serum creatinine 〉 1.5 mg/dl were 33.59 ± 9.19 ng/ml and 43.32 ± 9.02 ng/ml respectively.That was higher than that of non-AKI patients （27.94 ± 7.93 ng/ml,P =0.022,0.000,respectively）.Serum cystatin C was the independent risk factors associated with development of AKI by a multivariate logistic regression in patients with ACLF.Conclusions Serum cystatin C measurement may contribute to more earlier diagnosis of AKI even in patients with S.creatinine 〈 1.5 mg/dl.NGAL and MMP-9/NGAL-1 may be the biomarker of progress for ACLF.