血清胱抑素C在老年性急性肾损伤患者中早期诊断价值的研究

目的探讨血清胱抑素C(CysC)对老年性急性肾损伤(AKI)患者早期肾功能的评估价值。方法选取年龄大于或等于65岁,由门诊入院的41例符合2012年3月改善全球肾脏病预后组织(KIDIGO)发布的AKI诊断标准的老年患者(观察组)及68例健康体检者(对照组),采用酶法检测血清肌酐(Scr)水平,散射比浊法测定CysC水平,采用受试者工作特征曲线(ROC曲线)评价CysC对老年性AKI早期的诊断价值,应用Cockroft-Gault公式估算肾小球滤过率。结果观察组CysC水平较对照组明显升高(P0.05);观察组CysC与Scr呈明显线性相关(r=0.798,P0.05);CysC与肾小球滤过率呈负相关(r=-0.724,P0.05);ROC曲线分析得出CysC在老年性AKI的最佳截断值为1.67mg/L,Scr的最佳截断值为130.50μmol/L,诊断老年性AKI患者CysC的灵敏度明显高于Scr的灵敏度(P0.05)。在老年性AKI 1期和2期,CysC的灵敏度明显高于Scr(P0.05)。而在AKI 3期,两者的灵敏度差异无统计学意义(P0.05)。结论 CysC可作为老年性AKI患者肾小球滤过率的内源性标志物,对老年性AKI早期诊断具有重要价值。

The value of serum cystatin C for the early diagnosis of acute kidney injury in elderly patients

Objective To study the value of serum cystatin C for the early diagnosis of acute kidney injury in elderly patients .Methods To select the elderly patients aged above 65 years old ,41 cases with AKI(observation group)and sixty‐eight cases healthy controls(control group)were measured the serum creatinine with enzymic method and serum cystatin C with turbidimetry method .The diagnostic value of serum cystatin C and serum creatinine were detected by ROC .The estimated glomerular filtration rate was calculated with Cockroft‐Gault equation .Results The level of serum cystatin C and serum creatinine was significantly higher in the observation group than that in control group(P<0 .05) .Serum cystatin C was linearly correlated with serum creatinine(r=0 .798 ,P<0 .05) ,while nega‐tively related to glomerular filtration rate(r= -0 .724 ,P<0 .05) .The cut off of serum cystatin C was 1 .67 mg/L and serum creatinine was 130 .50 μmol/L in elderly patients with AKI .The sensitivity of serum cystatin C was obvi‐ously higher than that of serum creatinine in stage 1 and stage 2 patients with AKI (P<0 .05).For patients in stage 3 ,there was no significant difference in sensitivity(P>0 .05) .Conclusion Serum cystatin C can be one of the endog‐enous markers for glomerular filtration rate in the elderly patients with AKI ,and it can be used to diagnose AKI in the elderly patients much earlier than serum creatinine .