早期肾癌血清胱抑素C的改变及对肾脏功能评估的临床意义

Changes of Serum Cystatin C in Early Renal Carcinoma and Its Clinical Significance in Renal Function Evaluation

目的研究早期肾癌患者血清胱抑素C的改变及对肾脏功能评估的临床意义。方法回顾性分析50例已手术治疗的非老年肾透明细胞癌患者,术前99m Tc-DTPA肾动态显像测定肾小球滤过率,通过血清胱抑素C进行肾功能估值。根据肿瘤分期、病理结果、术中所见和尿常规潜血等临床情况分组,分析早期肾癌血清胱抑素C的变化及其对肾功能评估的临床意义。结果非老年早期肾透明细胞癌患者TNM分期为T1bN0M0期(P=0.046)、术中见肿瘤突出于肾脏表面生长并与周围组织粘连(P=0.015)、尿常规中发现潜血(P=0.000)时,术前血清胱抑素C升高。通过血清胱抑素C估计肾功能与核素肾动态显像测定值呈相关关系(r=0.305),但估值偏低。结论T1bN0M0期的早期肾透明细胞癌患者、肿瘤突出肾表与周围组织粘连、尿中出现潜血时,血清胱抑素C升高。患者肾功能正常时,血清胱抑素C升高可能与早期肾癌生长的侵袭性有关。由于血清胱抑素C升高受多种因素影响,术前必须结合肾动态显像评估肾脏功能。

Objective To study the changes of serum cystatin C in patients with early renal carcinoma and its clinical significance in renal function evaluation.Methods Retrospective analysis was performed on 50 cases of non elderly patients with renal clear cell carcinoma who had received surgical treatment,preoperative 99mTc DTPA renal dynamic imaging was employed to measure radionuclide glomerular filtration rate(rGFR),serum cystatin C was used to estimate renal function(eGFR).The patients were grouped according to clinical characteristics such as tumor stage,pathological results,intraoperative findings and urine occult blood to analyze the changes of serum cystatin C in early renal carcinoma and its clinical significance in the evaluation of renal function.Results The serum cystatin C was increased in the patients whose TNM stage was T1bN0M0(P=0.046),tumors was protruded from the renal surface and adhered to the surrounding tissues(P=0.015),and urine occult blood was positive(P=0.000).The eGFR value for evaluation of renal function by serum cystatin C was lower while it had a weak correlation with rGFR(r=0.305)measured by radionuclide renal dynamic imaging.Conclusion The serum cystatin C was increased in patients with early T1bN0M0 stage of renal clear cell carcinoma or whose tumor was protruded from the renal surface and adhered to the surrounding tissues,or urine occult blood was positive.When the patients had normal renal function,elevation in serum cystatin C may be associated with the aggressive growth of early renal carcinoma.Since cystatin C can be affected by many factors,preoperative renal function must be evaluated in combination with renal dynamic imaging.