胱抑素C评估社区获得性肺炎患者严重程度及预测住院期间死亡概率的临床研究

The role of cystatin C in evaluating the severity and predicting the hospital mortality of patients with community-acquired pneumonia

目的探索血清胱抑素C在评估社区获得性肺炎(community-acquired pneumonia,CAP)患者严重程度中的作用以及在预测患者住院死亡概率的临床价值。方法回顾性纳入2015年1月-2016年10月住院治疗的CAP患者176例,利用CURB-65评分评估患者严重程度,检测入院血清胱抑素C、C反应蛋白浓度,评估胱抑素C与CURB-65评分、C反应蛋白之间的关系,绘制受试者工作特征曲线分析胱抑素C预测CAP患者住院死亡概率的临床效率。结果 CAP患者胱抑素C浓度随着CURB-65评分的增加而增加(P<0.001),并且与C反应蛋白浓度呈正相关(rs=0.190,P<0.011)。22例CAP患者在住院期间死亡,死亡者胱抑素C浓度高于存活者,差异有统计学意义[(1.51±0.56)vs.(1.02±0.29)mg/L,P<0.001]。以1.18 mg/L为临界值,胱抑素C预测CAP患者住院死亡概率的灵敏度为68.18%,特异度为81.17%,受试者工作特征曲线下面积为0.793。联合检测胱抑素C与C反应蛋白有助于提高对住院死亡概率的预测价值。结论血清胱抑素C随着CAP严重程度的增加而升高,可作为评估CAP患者严重程度及预测住院死亡概率的临床标志物。

Objective To determine the role of serum cystatin C in evaluating the severity and predicting in- hospital mortality in patients with community-acquired pneumonia （CAP）. Methods The clinical data of 176 patients with CAP treated between January 2015 and October 2016 were collected in a retrospective way. The CURB-65 score was used to assess the severity. The serum levels of cystatin C and C-reactive protein （CRP） on admission were measured. The correlations between cystatin C and CURB-65 score and between cystatin C and CRP were calculated. Receiver operating characteristic curve was used to determine the ability of cystatin C in predicting in-hospital mortality. Results The serum level of cystatin C increased with the increasing CURB-65 score （P〈0.001）. The serum level of cystatin C was correlated positively with CRP level （rs=0.190, P〈0.011）. There were 22 patients died in hospital, the mean serum cystatin C level of non-survivor was significantly higher than that of survivors [（1.51±0.56） vs. （1.02±0.29） mg/L, P〈0.001]. At a cut-off 1.18 mg/L, the sensitivity and specificity of cystatin C in predicting in-hospital mortality were 68.18% and 81.17%, respectively. The area under the receiver operating characteristic curve was 0.793. The combination of cystatin C and CRP increased the predictive accuracy for in-hospital mortality. Conclusion Cystatin C level increases with the increaseing severity of CAP, and it may be a clinical biomarker to evaluate the severity and prognosis of patients with CAP.