外周血CysC及PA水平对急性有机磷中毒早期肝肾损伤的临床评估价值

Clinical value of Cystatin C and PA in the early liver and kidney damages of acute organic phosphorus poisoning

目的探讨外周血胱抑素C(CysC)及前白蛋白(PA)水平对急性有机磷中毒(AOPP)早期肝肾损伤的临床评估价值。方法选择2016年1月至2018年12月收治的188例AOPP患者为研究对象,其中轻度中毒患者为研究1组(n=94),重度中毒患者为研究2组(n=94)。另选择同时间段收治的进行常规体检的健康志愿者纳入此次研究,设为对照组(n=94)。三组均接受肝肾功能、外周血CysC及PA水平检测,并进行比较分析。结果研究2组的ALT、AST水平均高于研究1组和对照组,总蛋白、白蛋白水平均低于研究1组和对照组,差异有统计学意义(P<0.05);研究1组与对照组的ALT、AST、总蛋白、白蛋白水平比较,差异无统计学意义(P>0.05);研究2组的BUN、血Cr水平均高于研究1组和对照组,差异有统计学意义(P<0.05);研究1组与对照组的BUN、血Cr水平比较,差异无统计学意义(P>0.05);研究2组的CysC水平高于研究1组和对照组,PA水平低于研究1组和对照组,差异有统计学意义(P<0.05);研究1组与对照组的CysC及PA水平比较,差异无统计学意义(P>0.05);PA水平与ALT、AST呈负相关,与总蛋白、白蛋白呈正相关(P<0.05);CysC水平与BUN、血Cr呈正相关(P<0.05)。结论外周血CysC及PA检测对AOPP早期肝肾损伤的临床评估有重要价值,有助于临床医师明确患者的具体肝肾功能变化情况,以利于拟定针对性治疗方案。

Objective To investigate the clinical value of Cystatin C (CysC) and prealbumin (PA) in evaluation of early liver and kidney damages of acute organic phosphorus poisoning (AOPP). Methods A total of 188 AOPP patients admitted from January 2016 to December 2018 were selected as the study objects. Among them, patients with mild poisoning were set as study group 1 (n=94), and patients with severe poisoning were set as study group 2 (n=94). In addition, healthy volunteers who underwent routine physical examination during the same period were included in the study and set as control group (n=94). The liver and kidney function, the levels of CysC and PA in peripheral blood were measured, compared and analyzed among the three groups. Results The levels of ALT and AST in the study group 2 were higher than those in the study group 1 and control group, the levels of total protein and albumin were lower than those in the study group 1 and control group, and the differences were statistically significant (P<0.05). There were no significant differences in the levels of ALT, AST, total protein and albumin between the study group 1 and control group (P>0.05). The levels of BUN and blood Cr in the study group 2 were higher than those in the study group 1 and control group, and the differences were statistically significant (P<0.05). There were no significant differences in the levels of BUN and blood Cr between the study group 1 and control group (P>0.05). The level of CysC in the study group 2 was higher than that in the study group 1 and control group, the level of PA was lower than that in the study group 1 and control group, and the differences were statistically significant (P<0.05). There were no significant differences in the levels of CysC and PA between the study group 1 and control group (P>0.05). PA level was negatively correlated with ALT and AST, and positively correlated with total protein and albumin (P<0.05). CysC level was positively correlated with BUN and blood Cr (P<0.05). Conclusion The detection of CysC and PA in peripheral blood has important clinical application value for evaluation of early liver and kidney damages of AOPP. It can help clinicians to clarify the specific changes of liver and kidney function in patients, so as to work out targeted treatment plan.