尿胱抑素C预测非少尿型ATN近期结局的临床应用价值

目的：探讨尿胱抑素C预测非少尿型急性肾小管坏死（acutetubular necrosis，ATN）近期是否需要肾替代治疗（renal replacement therapy，RRT）的临床应用价值。方法：用ELISA法检测64例非少尿型ATN患者（均在发病3日内）的尿胱抑素C水平，观察此64例患者15日后的结局，根据有否行RRT分为RRT组及非RRT组，比较2组进入研究时的血清肌酐水平、尿流速、LLANO积分、尿胱抑素C水平，并比较后两者的接收者工作特征（receiver operating characteristic，ROC）曲线。结果：21例进入RRT纽，余43例为非RRT组。2纽进入研究时的血清肌酐及尿流速比较，差异均无统计学意义（均为P〉0．05）；而进入研究时，RRT组的尿胱抑素C水平比非RRT组显著升高（P〈0．01）；2组的LLANO积分比较差异亦有统计学意义（P〈0．05）。通过比较两者的ROC曲线，前者的敏感度、特异度均高于后者。结论：尿胱抑素C在近期结局不同的非少尿型ATN患者中存在明显的差异，可作为预测此类患者是否需要行RRT治疗的指标，其敏感度及特异度均高于LLANO积分，具有重要的临床应用价值。

The clinical application of urinary cystatin C in predicting the short-term outcome of nonoliguric acute tubular necrosis

Objective:To study the value of urinary cystatin C in predicting the need of renal placement therapy(RRT)in nonoliguric acute tubular necrosis(ATN).Methods:Urinary cystatin C was measured by ELISA in 64 patients with nonoliguric ATN and the 15 day-outcome was evaluated.Patients were divided into RRT and non-RRT groups according to whether the patients received RRT.Serum creatinine level,urine flow rate,LIANO scores and the receiver operating characteristic(ROC)curve of cystatin C on entry of the study were compared between the two groups.Results:Twenty-one patients entered the RRT group and 43 patients entered the non-RRT group.Serum creatinine level and urine flow rate on entry was not statistically significant between the two groups.However,the RRT group had significantly higher urinary cystatin C and LIANO score than those of the non-RRT group.Urinary cystatin C had higher sensitivity and specificity in identifying patients requiring RRT than those of LIANO score when comparing the ROC curves.Conclusion:There is significant difference in urinary cystatin C of patients with different short-term outcome of nonoliguric ATN.Increased urinary cystatin C has important clinical application in predicting patients requiring RRT,with higher sensitivity and specificity than those of LIANO score.