胱蛋白酶抑制剂C对原发性肾病综合征患者预后判断的临床意义

The relationship between Serum Cystatin-C and the outcome of Primary Nephrotic Syndrome

目的 测定原发性肾病综合征(PNS)患者血胱蛋白酶抑制剂C ( Cys-C ) 水平的变化,观察其与PNS治疗转归的关系。方法 39例明确诊断的PNS患者接受常规足量糖皮质激素疗程的治疗(1mg·kg-1·d-1),在治疗前(A期)和治疗至8～12周开始减量时(B期)分别测定血Cys-C水平,与20例正常人对照,同时与肌酐清除率(Ccr)进行对比。结果 39例PNS组患者根据糖皮质激素治疗情况和二年临床综合诊疗观察的结果,分为难治性肾病综合征(RNS)组19例和非难治性肾病综合征(NPNS)组20例。在A期和B期,PNS组患者的血Cys-C水平增高和对照组组间比较均有显著性意义(P<0.001,P<0.01),而他们的Ccr组间比较则没有显著性意义。RNS组的血Cys-C水平增高和NPNS组组间比较有显著性意义(P<0.05),而他们的Ccr组间比较也没有显著性意义。结论 在常规足量糖皮质激素治疗期,PNS患者的血Cys-C水平就比正常人水平明显升高,而PNS患者中,RNS患者比NPNS患者明显升高,提示高水平Cys-C的PNS患者预后不良。

Objetive To determine the relationship between the varies of Serum Cystatin-C (Cys-C) and the prognosis of Primary Nephrotic Syndrome (PNS). Methods A long term of two years prospectivestudy was undertaken in 39 cases with PNS who received normal glucocortoid therapy. Specimens of serumCys-C were detected and compared between the patients and 20 cases control group(health) before treatmentand after 8～12 weeks steroid therapy,and clearance of creatine were analyzed at the same time. Results39 cases with PNS were identified into 20 cases Normal Primary Nephrotic Syndrome (NPNS) and 19 casesRefratory Nephrotic Syndrome (RNS) groups according to the outcome of following up 2 years.Comparingcontrol group, serum Cys-C in PNS patients were significantly elevated at the point A and point B ( p<0.001and p<0.01, respectively ), but not Ccr.The concentration of serum CysC , excluding Ccr in RNSgroup was significantly higher in NPNS group(p<0.05 all).Conclusions Serum Cys-C in PNS wereincreased and more sensitive than Ccr. High levels of serum Cys-C were rather related to RNS than NPNS.