半胱氨酸蛋白酶抑制剂C在心脏术后急性肾损伤早期诊断的前瞻性研究

目的 探讨半胱氨酸蛋白酶抑制剂C(Cystatin C)在预测和诊断心脏术后急性肾损伤(AKI)中的价值.方法 前瞻性收集我院132例接受心肺旁路手术的病人,每位病人术前及术后每天采集血标本.同时应用酶法测血清肌酐(Scr),用颗粒增强透射免疫比浊法(PETIA)检测血清Cystatin C,用MDRD公式估算肾小球滤过率(eGFR).AKI运用ADQI的RIFLE标准进行诊断(R:Scr升高≥50%基础值,I:Scr升高≥100%基础值,F:Scr升高≥200%基础值,L:肾功能丧失;E:终末期肾脏病);同时AKI也按Cystatin C≥50%、≥100%和200%的标准进行诊断.结果 29(21.9%)例病人发生不同程度AKI,其中10例经历R标准,12例经历I标准,7例经历F标准.其余103例没有发生AKI的病人作为对照组.AKI病人的Cystatin C较非AKI病人显著升高(P<0.001),AKI病人的Cystatin C与Scr(r=0.732,P<0.001)、Cystatin C]-1与eGFR(r=0.803,P<0.001)成明显线性相关.分别按照Cystati nC和Scr两种方法 诊断AKI,不同程度AKI诊断的中位时间是:R标准的10例病人分别为2 d(1-4 d)和3 d(2～5 d)(P=0.014),I标准12例病人分别为3.5 d(1～6 d)和5 d(2～8 d)(P=0.008),F标准7例病人分别为5 d(3～7 d)和6.5 d(4～9 d)(P=0.02).ROC分析证实Cystatin C在AKI诊断中的准确性高(曲线下面积为0.992).当以Cystatin C升高≥50%作为AKI的诊断截点时.Cystatin C在AKI诊断中的敏感性和特异性分别为92%和95%.结论 Cystatin C可作为心肺旁路手术后AKI的诊断指标:Cystatin C在AKI的诊断时间上较Scr早,它可能作为AKI的早期预测指标之一.

Prospective study of cystatin C for diagnosis of acute kidney injury after cardiac surgery

Objective To prospectively study the value of cystatin C in diagnosis of acute kidney injury (AKI) in patients after cardiac surgery. Methods A total of 132 patients undergoing cardiopulmonary bypass were enrolled in this prospectively study. From each patient, blood samples were collected everyday before and after operation to detect the serum creatinine (Scr) and cystatin C levels by enzymatic method and particle-enhanced turbidimetric immunoassay (PETIA), respectively, and the glomerular filtration rate ...