半胱氨酸蛋白酶抑制剂C早期监测消化道穿孔伴腹膜炎患者并发肾功能损害的应用

Application of Cysteine Protease Inhibitor C in Early Monitoring of Patients with Digestive Tract Perforation and Peritonitis Complicated with Renal Function Impairment

目的探讨血半胱氨酸蛋白酶抑制剂C(CysC)在早期监测消化道穿孔伴腹膜炎并发肾功能损害(AKI)中的应用价值。方法选取2018年7月~2020年7月在自贡市第三人民医院接受诊治的85例DTPP患者为研究对象,测定患者血清肌酐(SCr)、24小时肌酐清除率(Ccr)及CysC水平,以CCr<80 ml/(min·1.73 m^(2))为肾功能损害诊断标准,分析CysC和SCr在早期诊断肾功能损害的准确性及二者与Ccr相关性,采用ROC曲线分析CysC和SCr对肾功能损害的诊断价值。结果85例中有23例出现CCr下降,其中有16例出现CysC上升,仅7例出现SCr异常。CysC对CCr的评估效能优于SCr,差异有统计学意义(P<0.05)。Pearson相关性分析显示,CysC与SCr均与CCr呈负相关(r=-0.595、-0.530,P<0.05),但SCr的相关系数低于CysC。ROC曲线分析显示,CysC曲线下面积(AUC)高于SCr(0.887 vs 0.844)。结论对于GFR的监测,CysC是一个较好的检测指标,在临床工作中常规检测消化道穿孔伴腹膜炎患者的CysC水平,有利于早期发现肾功能损害。

Objective To explore the application value of Cysteine Protease Inhibitor C(CysC)in early monitoring of digestive tract perforation with peritonitis and renal impairment(AKI).Methods A total of 85 DTPP patients who were diagnosed and treated in the Zigong Third People’s Hospital from July 2018 to July 2020 were selected as the research objects.Serum creatinine(SCr),24 h creatinine clearance(Ccr)and CysC levels were measured,and CCr<80 ml/(min·1.73 m^(2))was used as the diagnostic criteria for renal impairment.Analyze the accuracy of CysC and SCr in the early diagnosis of renal impairment and the correlation between the two and Ccr,The ROC curve was used to analyze the diagnostic value of CysC and SCr on renal impairment.Results Among the 85 cases,23 cases had a decrease in CCr,16 cases had an increase in CysC,and only 7 cases had an abnormal SCr.CysC was better than SCr in evaluating CCr,the difference was statistically significant(P<0.05).Pearson correlation analysis showed that CysC and SCr were negatively correlated with CCr(r=-0.595,-0.530,P<0.05).However,the correlation coefficient of SCr was lower than that of CysC.ROC curve analysis showed that the area under the CysC curve(AUC)was higher than SCr(0.887 vs 0.844).Conclusion For the monitoring of GFR,CysC is a good indicator.Routine detection of CysC levels in patients with gastrointestinal perforation and peritonitis in clinical work is helpful for early detection of renal damage.