胱抑素C、NGAL检测在肝硬化并发急性肾损伤早期诊断中的应用价值

Value of Cystatin C and NGAL in the Early Diagnosis of Liver Cirrhosis Complicated with Acute Renal Injury

目的探讨肝硬化并发急性肾损伤(LC-AKI)患者血清胱抑素C(Cys-C)及尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)检测水平的临床应用价值。方法回顾性分析郸城县第二人民医院2016年1月至2018年12月收治的118例LC-AKI患者(LC-AKI组)和120例肝硬化无继发急性肾损伤(对照组)患者的Cys-C、血清肌酐(SCr)、NGAL及24小时尿量的临床资料,比较两组以及LC-AKI组不同分期检测Cys-C、SCr、NGAL及24小时尿量的差异,采用Pearson分析Cys-C、NGAL与SCr、24小时尿量的相关性。结果 LC-AKI组患者Cys-C、SCr和NGAL检测水平高于对照组,24小时尿量低于对照组,差异有统计学意义(均P<0.05)。随着病情进展,Cys-C、SCr和NGAL检测水平呈现逐步升高的趋势,24小时尿量则呈逐步下降的趋势,Ⅰ期、Ⅱ期和Ⅲ期间比较,差异有统计学意义(均P<0.05)。LC-AKI组患者Cys-C和NGAL与SCr呈明显正相关,与24小时尿量呈负相关(均P<0.05),对照组患者Cys-C、NGAL与SCr、24小时尿量无关(均P>0.05)。在LC-AKI组Ⅰ期患者中Cys-C和NGAL联合检测的阳性检出率(92.68%)高于单项的阳性检出率,差异有统计学意义(均P<0.05)。结论 Cys-C和NGAL检测能早期发现肝硬化患者的肾功能损伤,可作为LC-AKI早期诊断指标,动态监测对LC-AKI的病情进展、评估预后等方面有较高的应用价值。

Objective To investigate the clinical value of serum cystatin C(Cys-C) and urinary neutrophil gelatinase-associated lipid carrier protein(NGAL) levels in patients with liver cirrhosis complicated with acute renal injury(LC-AKI).Methods The clinical data of Cys-C, serum creatinine(SCr), NGAL and 24-hour urine volume in 118 patients with LC-AKI(LC-AKI group) from January 2016 to December 2018 in the Second People’s Hospital of Dancheng and in 120 patients with cirrhosis without secondary acute renal injury(control group) were analyzed retrospectively. The differences of Cys-C, SCr, NGAL and 24-hour urine volume were compared between the two groups in different stages. Pearson was used to analyze the correlation between Cys-C, NGAL and SCr and 24-hour urine volume.Results The levels of Cys-C, SCr and NGAL in LC-AKI group were higher than those in control group, and the 24-hour urine volume was lower than that in control group, the differences were statistically significant(all P<0.05). As the disease progressed, Cys-C, SCr, and NGAL levels showed a gradual increase, and 24-hour urine levels showed a gradual decline. There were significant differences among Phase Ⅰ, Phase Ⅱ, and Ⅲ periods(all P<0.05). Cys-C and NGAL were positively correlated with SCr in LC-AKI group and negatively correlated with 24-hour urine volume(all P<0.05). Cys-C,NGAL were not correlated with SCr, 24-hour urine volume in control group(all P<0.05). The positive detection rate of Cys-C and NGAL in LC-AKI group of Phase Ⅰ(92.68%) were higher than that of single index, the differences were statistically significant(all P<0.05).Conclusion The detection of Cys-C and NGAL can detect the damage of renal function in patients with liver cirrhosis in the early stage. It can be used as an early diagnostic index of LC-AKI, and can be used to evaluate the prognosis and progression of LC-AKI.