血清胱抑素C及其估算肾小球滤过率对肝硬化患者肾功能损害的诊断价值研究

Serum cystatin C and its estimation of glomerular filtration rate in diagnosis of renal function damage in patients with liver cirrhosis

目的探讨血清胱抑素C(Cys C)及其估算肾小球滤过率(eGFR)对肝硬化患者肾功能损害的诊断价值。方法回顾性分析我院300例肝硬化患者的临床资料,根据诊断结果将患者分为单纯肝硬化组(对照组)145例和肝硬化肾功能损害组(观察组)155例,检测Cys C、血清肌酐(SCr)及血尿素氮(BUN)水平,并以Cys C计算eGFR,分析血清Cys C、eGFR与SCr、BUN的相关性,利用受试者工作特征(ROC)曲线分析Cys C、SCr、BUN及eGFR对肝硬化患者肾功能损害的诊断价值。结果观察组Cys C、SCr及BUN水平均高于对照组,eGFR水平低于对照组(P<0.05);血清Cys C与SCr、BUN呈正相关,eGFR与SCr、BUN呈负相关(P<0.05);血清Cys C、SCr、BUN及eGFR指标ROC曲线下面积均>0.5,血清Cys C联合eGFR诊断肝硬化患者肾功能损害的灵敏度为88.34%,特异度为96.35%。结论血清Cys C与eGFR指标联合对肝硬化患者肾功能损害的诊断具有一定的临床意义,可显著提高其诊断的准确性。

Objective To investigate the diagnostic value of serum cystatin C（ CysC） and its estimation of glomerular filtration rate（ eGFR） in patients with liver cirrhosis.Methods Three hundred patients with liver cirrhosis in our hospital from July 2015 to September 2017 were selected as the research objects.All patients were analyzed retrospectively from their clinical data.According to the diagnostic results,they were divided into pure cirrhosis（ n = 145,control group） and cirrhosis patients with renal impairment group（ n= 155,observation group）.Their levels of CysC,serum creatinine（ SCr） and blood urea nitrogen（ BUN） were measured and eGFR was calculated from CysC.At the same time,the relationship between serum CysC,eGFR,SCr and BUN was analyzed. The ROC curve was used to analyze the diagnostic value of CysC,SCr,BUN and eGFR in these patients.Results The levels of CysC,SCr and BUN in the observation group were significantly higher than those in the control group while the levels of eGFR in the observation group were lower than those in the control group（ P〈0. 05）.Serum CysC was positively correlated with SCr and BUN while eGFR was negatively correlated with SCr and BUN（ P〈0. 05）.The areas under the ROC curve of serum CysC,SCr,BUN and eGFR were all greater than 0. 5.The sensitivity of serum CysC combined with eGFR for the diagnosis of renal dysfunction in patients with liver cirrhosis was 88. 34% and the specificity was 96. 35%.Conclusion The combination of serum CysC and eGFR indicators has clinical significance for the diagnosis of renal dysfunction in cirrhotic patients,which can significantly improve the diagnostic accuracy.