新型冠状病毒肺炎并发急性肾损伤患者血清胱抑素C,尿素氮和肌酐水平变化及临床价值研究

Variation of Level,Risk Factors and Clinical Value Research of Serum Cystatin C,Blood Urea Nitrogen and Creatinine in Patients with COVID-19 Complicated with Acute Kidney Injury

目的探讨血清胱抑素C(cystatin C,Cys-C)、尿素氮(blood urea nitrogen,BUN)和肌酐(creatinine,Cr)在新型冠状病毒肺炎并发急性肾损伤患者的水平变化、危险因素评估及临床应用价值。方法选取2020年1月~3月长沙市第一医院公共卫生救治中心收治的120例新型冠状病毒(COVID-19)确诊患者,按照《新型冠状病毒肺炎诊疗方案(试行第七版)》分为普通型、轻型、重症型及危重型四种,根据改善全球肾脏病预后组织(Kidney Disease Improving Global Outcomes,KDIGO)指南、既往病史和临床症状将患者分为急性肾损伤(acute kidney injury,AKI)组15例与非急性肾损伤(non acute kidney injury,NAKI)组105例,通过收集整理病人的一般资料、入院症状及血清Cys-C,BUN和Cr的实验室检查结果,统计分析COVID-19患者AKI组与NAKI组患者间各项指标的水平变化;并采用多因素Logistic回归分析COVID-19并发AKI的危险因素。结果该研究纳入的COVID-19患者,AKI组与NAKI组的性别构成比比较差异无统计学意义(χ^(2)=1.193,P>0.05);AKI组与非AKI组的年龄构成比比较,AKI组平均年龄大于NAKI组,差异有统计学意义(t=12.469,P<0.05);COVID-19患者血清Cys-C,BUN和Cr水平在普通型和重症型之间比较差异无统计学意义(t=2.464,P>0.05);危重组患者血清Cys-C,BUN和Cr水平明显高于重症组(t=9.164,7.342,11.255,均P<0.05),危重组患者血清Cys-C,BUN和Cr水平明显高于普通组(t=24.958,15.461,19.224,均P<0.001),差异均有统计学意义。AKI组与NAKI组在入院初期的血清Cys-C,BUN和Cr水平差异无统计学意义(t=0.274,0.308,1.253,均P>0.05);AKI组患者入院进展期血清Cys-C,BUN和Cr水平明显高于NAKI组(t=22.144,16.325,33.289,均P<0.001),AKI组患者入院恢复期平均血清Cys-C,BUN和Cr水平明显高于NAKI组(t=10.498,4.326,8.794,均P<0.05),差异均有统计学意义。Logistic回归分析结果表明,高龄(OR=3.25,95%CI:1.12~8.09,P<0.001)、有基础疾病如糖尿病(OR=2.15,95%CI:1.02~7.55,P=0.039)、有基础疾病如高血压病(OR=2.27,95%CI:1.24~7.66,P=0.025)、高C反应蛋白(OR=2.01,95%CI:1.45~2.29,P<0.001)、高Cr(OR=1.09,95%CI:0.98~1.28,P=0.08)和高Cys-C(OR=3.01,95%CI:1.95~2.48,P<0.001)是COVID-19并发AKI的主要危险因素。结论Cys-C,BUN和Cr三个指标的联合动态检测在新冠肺炎患者,尤其在危重型高龄患者的肾损伤评估和监测中起重要作用,对于判断COVID-19并发AKI患者的病情危重、疾病发展及预后评估具有重要的临床应用价值。高龄、有基础疾病(糖尿病、高血压)及C反应蛋白、肌酐、胱抑素C水平升高是COVID-19患者并发AKI的主要危险因素。

Objective To discuss variation of level,risk factors and clinical application value of serum cystatin C(Cys-C),blood urea nitrogen(BUN)and creatinine(Cr)in patients with COVID-19 complicated with acute kidney injury.Methods Selection 120 cases of COVID 19 confirmed patients treated by the North Hospital of Changsha First Hospital from January to March 2020.Patients were divided into mild type,normal type,severe type and critical type according to“the Protocol of Diagnosis and Treatment with COVID-19(Trial Seventh Edition)”.Patients were divided into acute kidney injury(AKI)group(n=15)and non-acute kidney injury(NAKI)group(n=105)according to(Kidney Disease Improving Global Outcomes,KDIGO)guidelines,past medical history and clinical symptoms.And to statistically analyzed the level changes of various indicators between the AKI group and the NAKI group of COVID-19 patients by collecting the general information,hospitalization symptoms and laboratory results of serum Cys-C,BUN and Cr.And analyze the risk factors of COVID-19 complicated with AKI according to multivariate Logistic regression.Results Based on patients with COVID-19,there was no statistical significance in gender composition between AKI group and NAKI group(t=1.193,P>0.05),there age composition ratio between AKI group and NAKI group,the average age of AKI group was higher than that of NAKI group,the difference was statistically significant(t=12.469,P<0.05).And there was no significant difference in Cys-C,BUN and Cr between common group and group type(t=2.464,P>0.05).The mean serum levels of Cys-C,BUN and Cr in critical group were significantly higher than those in severe group(t=9.164,7.342,11.255,all P<0.05),and the mean serum levels of Cys-C,BUN and Cr in critical group were significantly higher than those in common group(t=24.958,15.461,19.224,all P<0.001),the differeences were statistically significant,respectively.The average serum levels of Cys-C,BUN and Cr at the beginning of admission were not statistically significant between AKI group and NAKI group(t=0.274,0.308,1.253,all P>0.05),average serum levels of Cys-C,BUN and Cr in AKI group were significantly higher than those in NAKI group in the advanced stage of admission(t=22.144,16.325,33.289,all P<0.001),the mean serum levels of Cys-C,BUN and Cr in AKI group were significantly higher than those in NAKI group in the convalescing stage(t=10.498,4.326,8.794,all P<0.05),the differeences were statistically significant,respectively.Logistic regression analysis showed that,Old age(OR=3.25,95%CI:1.12~8.09,P<0.001),basic diseases such as diabetes(OR=2.15,95%CI:1.02~7.55,P=0.039),hypertension(OR=2.27,95%CI:1.24~7.66,P=0.025),C-reactive protein(OR=2.01,95%CI:1.45~2.29,P<0.001),Cr(OR=1.09,95%CI:0.98~1.28,P=0.08),Cys-C(OR=3.01,95%CI:1.95~2.48,P<0.001)were the main risk factors for COVID-19 with AKI.Conclusion The combined dynamic detection of Cys-C,BUN and Cr especially in critically ill elderly patients plays an important role in the evaluation and monitoring of kidney injury in patients with COVID-19,it has important clinical application value for judging the severity,disease development and prognosis of COVID-19 patients with AKI.Advanced age,underlying diseases(Diabetes,High blood pressure),and elevated levels of C-reactive protein,Cr and Cys-C are the main risk factors for COVID-19 patients with AKI.