胱抑素C对失代偿期肝硬化患者并发肝肾综合征的预测价值

The predictive value of cystatin C in patients with decompensated liver cirrhosis complicated with hepatorenal syndrome

目的探讨胱抑素C(CysC)在失代偿期肝硬化并发肝肾综合征(hepatorenal syndrome,HRS)患者中的诊断价值。方法收集失代偿期肝硬化患者共132例,根据有无并发HRS,分为HRS组和非HRS组,用统计学方法分析两组患者的性别、年龄、病因及Cys C、肌酐(Scr)、尿素氮(BUN)、总胆红素(TBil)、白蛋白(Alb)、凝血酶原时间(PT)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)、尿酸(UA)、钾离子(K^+)、氯离子(Cl^-)、钠离子(Na^+)、钙离子(Ca^(2+))、国际标准化比值(INR)的水平。结果两组患者在年龄、性别方面差异无统计学意义(P>0.05)。两组患者Cys C、Scr、AST、ALP、Na^+水平比较,差异有统计学意义(P<0.05);而两组患者BUN、TBil、Alb、PT、ALT、UA、K^+、Cl^-、Ca^(2+)、INR水平比较,差异无统计学意义(P>0.05)。将两组患者的Cys C、Scr、BUN、TBil、Alb、PT、AST、ALT、ALP、UA、K^+、Na^+、Cl^-、Ca^(2+)、INR等生化指标行单因素Logistic回归分析,发现Cys C、Scr、AST、ALP、Na^+为预测HRS发生的有意义因素,再行多因素Logistic回归分析,发现Cys C和Scr是影响HRS的独立危险因素。绘制Cys C、Scr、BUN的ROC曲线,曲线下面积(AUC)分别为0.731、0.640、0.575。结论Cys C和Scr是影响HRS的独立危险因素。Cys C较Scr和BUN对失代偿期肝硬化并发HRS的临床预测价值更好。

Objective To investigate the diagnostic value of cystatin C(CysC)in patients with decompensated liver cirrhosis complicated with hepatorenal syndrome(HRS).Methods A total of 132 patients with decompensated liver cirrhosis were collected and classified into HRS group and non-HRS group according to the presence or absence of concurrent HRS.Statistical analysis was performed.Gender,age,etiology,and CysC,creatinine(Scr),urea nitrogen(BUN),total bilirubin(TBil),albumin(Alb),prothrombin time(PT),aspartate aminotransferase(AST),alanine aminotransferase(ALT),alkaline phosphatase(ALP),uric acid(UA),potassium ion(K+),chloride ion(Cl-),sodium ion(Na+),Calcium(Ca 2+),and international normalized ratio(INR)levels were analyzed in two groups.Results There was no significant difference in age and gender between two groups(P>0.05).The levels of CysC,Scr,AST,ALP and Na+were statistically significant between two groups(P<0.05).There was no significant difference in levels of BUN,TBil,Alb,PT,ALT,UA,K+,Cl-,Ca 2+,INR between two groups(P>0.05).The Logistic regression analysis was performed on the biochemical indicators of CysC,Scr,BUN,TBil,Alb,PT,AST,ALT,ALP,UA,K+,Na+,Cl-,Ca 2+,INR in two groups.The results showed that CysC,Scr,AST,ALP and Na+were the significant factors for predicting the occurrence of HRS.Multivariate Logistic regression analysis showed that CysC and Scr were independent risk factors affecting HRS.The area under the curve(AUC)of CysC,Scr and BUN were 0.731,0.640,and 0.575,respectively.Conclusion CysC and Scr are independent risk factors affecting HRS.Compared with Scr and BUN,CysC has better clinical predictive value for decompensated liver cirrhosis complicated with HRS.