血清胱抑素C在ICU危重患者急性肾损伤早期诊断中的价值

目的：探讨血清胱抑素C在重症患者伴有急性肾损伤早期诊断中的价值。方法：对ICU中39例发生AKI者（观察组）及32例未发生AKI者（对照组）,采用酶法测血清肌酐水平,透射比浊法测血清胱抑素C水平,采用ROC评价血清胱抑素C的诊断价值,应用Cockroft-Gault公式估算肾小球滤过率。结果：观察组患者血清胱抑素C较对照组明显升高（P〈0.05）,观察组血清胱抑素C与血清肌酐呈正相关关系（r=0.683,P〈0.05）,与肾小球滤过率呈负相关关系（r=-0.346,P〈0.05）。ROC得出血清胱抑素C最佳截断值为1.65mg/L,肌酐最佳截断值为128.8μmol/L。急性肾损伤1期患者血清胱抑素C灵敏度（85%）,高于血清肌酐灵敏度（70%）,且出现异常的时间要早于肌酐。急性肾损伤2、3期患者间灵敏度比较差异无统计学意义（P〉0.05）。结论：在危重患者中血清胱抑素C可作为急性肾损伤肾小球滤过率的内源性标志物,对急性肾损伤患者早期诊断有重要作用。

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

Objective：To study the diagnostic value of serum cystatin C in critically patients with acute kidney injury. Method：Thirty-nine cases with AKI （observation group） and thirty-two cases without AKI （control group） were admitted in this study. Serum level of creatinine, cystatin C were measured by enzyme and turbidimetry meth-od. Serum cystatin C diagnostic value and glomerular filtration rate were detected by ROC and Cockroft-Gault e-quation. Result： The increased serum cystatin C in AKI group was positively related to serum creatinine（r=0. 683, P〈0.05） ,while negatively related to glomerular filtration rate（r=-0. 346 ,P〈0.05）. The optimal cut off value of serum cystatin C and creatinine was 1.65 mg/L and 128.8 μ mol/L,respectively. The sensitivity of serum cysta-tin C was significantly higher than that of serum creatinine in AKI stage I （85% vs 70% ）. For patients in stage Ⅱ and Ⅲ, no significant difference was shown between the serum cystatin C and creatinine. Conclusion：Serum cystatin C can be one of the endogenous markers for glomerular filtration rate in the critical patients with acute kidney inju-ry,and it can diagnose acute kidney injury much earlier than serum creatinine.