胱抑素C、血浆尾加压素Ⅱ在失代偿期肝硬化合并肝肾综合征患者中的诊断价值

目的探讨胱抑素C（CysC）、血浆尾加压素Ⅱ（uⅡ）在失代偿期肝硬化合并肝肾综合征（HRS）患者中的诊断价值。方法收集2011年2月-2011年11月于常州市第一人民医院消化内科住院的失代偿期肝硬化患者50例,计算其校正内生肌酐清除率（Ccr）,并根据Ccr分为单纯肝硬化组、亚临床HRS组及HRS组,以15例健康体检者为对照组,检测ALT、AST、总胆汁酸（TBA）、Alb、血清肌酐（Scr）、CysC、uⅡ浓度,比较各组上述指标的差异,若数据成正态分布且方差齐,进行单因素方差分析（One-Way ANOVA）,两组间比较采用t检验;否则,多组间进行非参数秩和检验（Kruskall-Wallis H test）,两组间比较使用Mann-Whjtney U检验。相关分析采用Spearman相关检验。并通过绘制CysC、uⅡ浓度判断肝硬化合并亚临床HRS及HRS的ROC曲线,获得其曲线下面积（AUC）及最佳临界值。结果肝硬化病例组与正常对照组ALT、AST、TBA、Alb、Scr、Cysc、uⅡ比较差异有统计学意义。单纯肝硬化组、亚临床HRS组及HRS组CysC、uⅡ浓度均呈升高趋势,差异具有统计学意义（P〈0.05）。CysC和uⅡ判断亚临床HRS的AUC分别为0.91和0.867,其最佳临界值分别为1.40 mg/L、299.06 pg/ml。CysC和uⅡ判断HRS的AUC分别为0.942和0.901,其最佳临界值分别为2.22 mg/L、321pg/ml。结论 CysC、uⅡ浓度在患者血清肌酐正常时就出现升高改变,有助于早期发现亚临床HRS。CysC、uⅡ浓度对失代偿期肝硬化患者并发亚临床HRS及HRS有很好的判别价值。     

血清Cystatin C测定在亚临床肝肾综合征诊断中的价值

目的 建立血清半胱氨酸蛋白酶抑制物C(Cystatin C,Cys C)的定量ELISA检测方法,探讨血清Cys C水平在肝肾综合征(HRS)早期诊断中的价值.方法 用ELISA法测定81例常规检查肾功能正常的肝硬化患者和26例健康体检者的血清Cys C水平,同时检测其血肌酐(Scr)、尿素氮(BUN)及尿肌酐(Ucr),算出校正24 h肌酐清除率(Ccr)作为肾小球滤过率标准,40≤Ccr＜80 ml·min-1·1.73 m-2的肝硬化患者被列为亚临床HRS组.结果 亚临床HRS组血清Cys C浓度明显高于单纯肝硬化组(P＜0.05);而Scr、BUN在两组的差别无统计学意义.Cys C与Ccr相关性比Scr与Ccr相关性好(r=-0.91对r=-0.72,P＜0.05);受试者工作特征曲线(ROC)分析显示Cys C曲线优于Scr.结论 血清Cys C较Scr、BUN能更敏感地检测出肝硬化患者的轻度肾功能损害,可作为识别亚临床HRS的一项新指标.     

儿童肾功能损害不同时期血清胱抑素C的变化及意义

检测肾功能正常组、肾功能不全代偿组、肾功能不全失代偿组、肾衰竭组、终末肾组的血清胱抑素C(CysC)血清肌酐(Scr)、内生肌酐清除率(Ccr)水平,并对CysC与Scr、Ccr的关系进行直线相关分析.结果 血清CysC在肾功能损伤的不同时期水平均升高,且随着损伤程度的加重而明显升高,与Scr呈正相关(r=0.867,P<0.01),与Ccr呈负相关(r=-0.834,P<0.01).认为CysC能准确反映肾功能损害的严重程度及肾小球滤过功能,是肾功能损害早期的敏感指标,其敏感性和特异性优于Scr、Ccr,且操作简便、易行,可做为测定GFR的敏感内源性标志物.     

2型糖尿病肾病血清胱抑素C与高敏C反应蛋白检测的意义

目的 探讨血清胱抑素C(CysC)和高敏C反应蛋白(hs-CRP)诊断早期糖尿病肾病(DN)的意义.方法 89例2型塘尿病(T2DM)患者,采用全自动生化分析仪测定血清中的CysC、hs-CRP、肌酐(Scr)浓度.计算内生肌酐消除率(Ccr).结果 T2DM组Cy8c和hs-CRP含量明显高于对照组(P<0.01),联合检测阳性率达为83.1%,明显高于单项检测.结论 血清CysC及hs-CRP单独检测及联合检测均优于Ccr,可以替代Ccr用于早期DN的诊断.     

62例DN患者血清CysC水平测定及意义

目的为临床判定糖尿病肾病（DN）患者肾小球滤过功能提供可靠、敏感指标。方法选择62例DN患者（DN组）,分别经肾小球滤过率（GFR）测定诊断为肾功无损、。肾功受损代偿和肾功受损失代偿;同时选择28例缝康查体人员作为对照组。两组均采用免疫透射比浊法测定血清胱抑素c（Cysc）、β2-微球蛋白（β2-MG）水平,采用酶法测定电清肌酐（Cr）水平,分析三种指标与GFR的相关性。结果DN组血清CysC、β2-MC、Cr水平显著高于对照组（P〈0．01）;DN组除肾功无损者血清Cr水平与GFR无明显相关性外,余患者各项指标与GFR均有明显相关性（P〈0．01）,且以CysC相关系数最大。结论血清CysC用于判定肾小球滤过功能可靠、敏感,其检测价值优于β2-MG和Cr。     

胱抑素与老年肌酐正常肾损害患者肾小球滤过率的相关性研究

目的探讨在血清肌酐正常的老年肾损害患者中,胱抑素(cystatinC,Cys-C)对肾小球滤过率(GFR)评价的意义。方法对2002-11~2003-12泸州医学院附属医院86例有肾损害但血清肌酐(Scr)正常的老年患者,应用乳胶颗粒增强比浊法测定血清中Cys-C浓度,并采用CockCroft-Cault公式计算内生肌酐清除率(Ccr)。分别比较Cys-C与Scr和Ccr的相关性。结果56例Cys-C升高超过正常,占56.1%;比较Ccr≤59mL/min和Ccr>59mL/min两组间的Cys-C质量浓度发现,当Ccr≤50mL/min时,97.1%的患者Cys-C超过正常,在Ccr>59mL/min时,已有44.2%患者Cys-C超过正常。血清Cys-C与Scr存在高度的正直线相关(r=0.89,P<0.01);Cys-C与Ccr存在高度的负直线相关(r=-0.87,P<0.01)。结论在老年患者中,Cys-C比Scr和Ccr更敏感地反映早期肾小球滤过率的下降。     

肝肾综合征患者血浆白三烯C4检测及其作用

目的:观察肝肾综合征(HRS)、失代偿性肝硬化病人血浆白三烯C_4(LTC_4)的水平及其与肾功能损害的关系。方法:检测HRS、失代偿性肝硬化而肾功能正常患者和正常对照组的血浆LTC_4和肌酐浓度。结果:失代偿性肝硬化患者血浆LTC_4增高,合并HRS者增高更显著,HRS患者血浆LTC_4与肌酐浓度有显著相关性。结论:LTC_4在肝硬化并发HRS的过程中具有重要作用。     

半胱氨酸蛋白酶抑制剂C对老年患者造影剂肾病的诊断价值

目的探讨非离子型造影剂对老年患者肾功能的影响,以及血清半胱氨酸蛋白酶抑制剂C(CysC)在早期诊断造影剂肾病的临床价值。方法选择年龄70岁、肾功能正常并行冠状动脉介入治疗的老年患者50例(PCI组)和健康体检者50例(对照组),于术前及术后第1、2、3、5天采用苦味酸法检测血肌酐,采用颗粒增强透射免疫比浊法检测血清CysC,并计算内生肌酐清除率(Ccr)。采用工作特征曲线下面积评价比较CysC和肌酐对造影剂肾病的诊断效率。结果与术前比较,PCI组患者术后第2、3天Ccr明显下降,术后第1、2天CysC明显升高(P0.05),而血肌酐与术前比较无明显变化;以CysC为标准诊断,造影剂肾病的诊断效率明显优于血肌酐。结论在老年患者中,监测血肌酐预测造影剂肾病发生可能造成漏诊,血清CysC可更敏感地反映造影剂肾毒性的程度,有利于早期准确识别造影剂肾损害。     

肝病高动力循环与内毒素、肿瘤坏死因子-α和NO水平的相关性研究

探讨肝硬化患者血浆LPS,TNF-α和NO水平的变化及其在肝硬化门脉高压血流动力学紊乱中的作用。检测了45例肝硬化患者(其中代偿期、失代偿期分别为22、23例)血浆LPS,TNF-α和NO水平,并对受试者的血液动力学指标(包括心输出量、心脏指数、外周血管阻力和门静脉血流量)进行同步观察。肝硬化失代偿期患者血浆LPS,TNF-α和NO水平明显高于代偿期(P<0．01),三者之间呈正相关(P<0．001);肝硬化失代偿期患者心输出量、心脏指数、门静脉血流量明显高于代偿期患者(P<0．01),外周血管阻力明显低于代偿期患者(P< 0．01);肝硬化患者血浆NO水平与心输出量、心脏指数、门静脉血流量呈显著性正相关(P<0．001),与外周血管阻力呈显著性负相关(P<0．001)。肝硬化患者血浆LPS,TNF-α和NO生成增多,NO在门脉高压形成及血液动力学紊乱中起重要作用。     

胱抑素C对失代偿期肝硬化患者并发肝肾综合征的预测价值

目的探讨胱抑素C(CysC)在失代偿期肝硬化并发肝肾综合征(hepatorenal syndrome,HRS)患者中的诊断价值。方法收集失代偿期肝硬化患者共132例,根据有无并发HRS,分为HRS组和非HRS组,用统计学方法分析两组患者的性别、年龄、病因及Cys C、肌酐(Scr)、尿素氮(BUN)、总胆红素(TBil)、白蛋白(Alb)、凝血酶原时间(PT)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)、尿酸(UA)、钾离子(K~+)、氯离子(Cl~-)、钠离子(Na~+)、钙离子(Ca~(2+))、国际标准化比值(INR)的水平。结果两组患者在年龄、性别方面差异无统计学意义(P0.05)。两组患者Cys C、Scr、AST、ALP、Na~+水平比较,差异有统计学意义(P0.05);而两组患者BUN、TBil、Alb、PT、ALT、UA、K~+、Cl~-、Ca~(2+)、INR水平比较,差异无统计学意义(P0.05)。将两组患者的Cys C、Scr、BUN、TBil、Alb、PT、AST、ALT、ALP、UA、K~+、Na~+、Cl~-、Ca~(2+)、INR等生化指标行单因素Logistic回归分析,发现Cys C、Scr、AST、ALP、Na~+为预测HRS发生的有意义因素,再行多因素Logistic回归分析,发现Cys C和Scr是影响HRS的独立危险因素。绘制Cys C、Scr、BUN的ROC曲线,曲线下面积(AUC)分别为0.731、0.640、0.575。结论Cys C和Scr是影响HRS的独立危险因素。Cys C较Scr和BUN对失代偿期肝硬化并发HRS的临床预测价值更好。     

老年患者增强CT检查所致肾损伤的危险性评价及糖尿病对其影响

目的研究老年患者增强CT检查所致的肾损害的情况及糖尿病对其影响。方法纳入符合入组条件的患者129例,其中糖尿病组40例,无糖尿病组89例。所有患者于增强CT检查前、检查后24h和48h留取静脉血检测。肾功能参数：血肌酐（Scr）、血尿素氮（BUN）和半胱氨酸蛋白酶抑制剂C（CysC）,根据Cockroft-Gault公式计算Ccr。取造影剂应用后24h、48h各。肾功能指标最高值作为其峰值,各指标的峰值与造影剂应用前相应肾功能指标的差值作为APeak（AScr、ACcr、ABUN和ACysC）。对比所有入组患者增强CT检查前后的。肾功能参数,并对糖尿病和无糖尿病患者进行分组,对比两组患者增强CT检查后肾功能参数的变化。结果入组患者平均年龄（77．6±6．6）岁。所有入组老年患者,增强CT检查后24hScr[（88．16±20．54）vs（82．07±20．06）,P=0．017]和CysC[（1．61±0．42）vs（1．40±O．36）,P〈0．001]较造影前升高。所有入组老年患者,造影后48hScr、Ccr、BUN和CysC与造影前比较虽有差别,但无统计学意义。造影后峰值与造影前肾功能指标相比,Scr[（90．57±20．75）VS（82．07±20．06）,P=0．001]和CysC[（1．65±O．50）vs（1．40±0．36）,P〈0．001]均升高,Ccr较造影前降低[（58．71±16．19）VS（63．15±17．06）,P=0．033]。应用造影剂后,糖尿病组AScr[（10．38±7．77）vs（7．65±6．23）,P=0．036]和ACysC[（0．34±0．20）vs（0．21±0．27）,P=0．009]均高于无糖尿病组。结论老年患者增强CT检查有明显的肾功能损害,造影剂应用后24h最明显,除年龄外,糖尿病是老年造影剂。肾脏损伤的重要危险因素之一。     

血清胱抑素C在MDR-TB患者化疗中的临床应用

目的探讨血清胱抑素c（CysC）在耐多药结核（MDR—TB）患者化学治疗中的临床应用。方法对MDR—TB患者按照化疗时间不同分7组检测血清CysC,来判断患者化疗过程中氨基糖甙类注射剂及高尿酸血症对患者肾功能损伤情况,同时将7个组的血清肌酐（Scr）、尿素（Urea）、尿酸（UA）的浓度作为观察指标来测定。结果七组的血清CysC、Scr、UA的差异有显著性意义（P〈0．05）,血清Urea的差异无显著性意义（P〉0．05）,但与治疗前组相比血清CysC的浓度的变化较Scr的浓度变化出现早;在MDR-TB患者化疗过程中血清SCr、Urea无一例异常,血清uA在治疗不同时期大多数患者间或或者持续升高,血清CysC有两例在治疗2个月后出现异常,经调减注射剂剂量后恢复正常。结论血清CysC是监测MDR-TB患者化疗过程中早期肾功能损伤更敏感的指标。     

老年Ⅱ型糖尿病性肾病脂蛋白(a)与肾功能不全的关系

目的探讨脂蛋白(a)(Lp(a))与老年糖尿病性肾病肾功能不全的关系。方法分析47例老年对照组和141例不同肾小球滤过率的老年糖尿病肾病患者的脂蛋白(a)、血脂及载脂蛋白浓度的变化。结果老年糖尿病性肾病肾功能正常组Lp(a)己有升高趋势(P=0.072),随着肾功能的减退Lp(a)显著增高(P<0.001),并且与肾小球滤过率呈负相关,同时冠心病和脑血管病发生率也明显上升。结论Lp(a)升高在老年糖尿病性肾病肾功能不全的发展过程中起重要作用。     

The role of duplex-doppler ultrasonography in the diagnosis of renal dysfunction and hepatorenal syndrome in patients with liver cirrhosis

BACKGROUND/AIMS: Kidney dysfunction commonly develops in patients with liver cirrhosis. Renal failure develops due to renal vascular constriction and can be present weeks or even months before clinical signs or increased levels of blood urea nitrogen or serum creatinine concentrations become detectible. The objective of this study was to analyze the value of renal interlobar arterial resistance index, measured by duplex-Doppler ultrasonography for detecting early impairment of renal function in patients with liver cirrhosis and its possible use in detecting a subgroup of patients with a higher risk of developing hepatorenal syndrome. METHODOLOGY: The patients were divided into three groups: patients with liver cirrhosis and normal renal function (n=31), patients with liver cirrhosis and renal failure but without hepatorenal syndrome criteria (n=9), and patients with hepatorenal syndrome (n=6). The interlobar arterial resistance index was estimated with duplex Doppler ultrasonography, and liver and renal function tests were measured in all patients. RESULTS: The average value of interlobar arterial resistance index in patients with hepatorenal syndrome (0.74+/-0.01) was statistically significantly higher than interlobar arterial resistance index values measured in liver cirrhosis patients without the signs of azotemia (0.65+/-0.03) or in those with liver cirrhosis and kidney dysfunction, but without hepatorenal syndrome (0.67+/-0.01). In all patients with hepatorenal syndrome the value of interlobar arterial resistance index was over 0.70. In the group of patients with liver cirrhosis and kidney dysfunction, but without hepatorenal syndrome, interlobar arterial resistance index was below 0.70 in seven, whereas in the remaining two interlobar arterial resistance index was above 0.70. In those patients renal dysfunction displayed a progressive form and hepatorenal syndrome developed. CONCLUSIONS: Duplex-Doppler ultrasound of intralobar arteries is a simple, effective and non-invasive method which enables the early detection of renal hemodynamic disturbances in patients with liver cirrhosis even before renal dysfunction becomes clinically evident. It also makes possible the identification of a subgroup of patients with liver cirrhosis who are at higher risks for developing hepatorenal syndrome.     

Serum cystatin C in diabetic patients. Not only an indicator for renal dysfunction in patients with overt nephropathy but also a predictor for cardiovascular events in patients without nephropathy

Serum cystatin C (CysC) has been proposed as a potentially superior marker for the evaluation of renal function because it was more sensitive and accurate for the estimation of glomerular filtration rate (GFR) than other markers. We evaluated the clinical usefulness of CysC in diabetic nephropathy. The study was performed on 414 Japanese diabetic patients. We compared serum CysC levels with serum creatinine levels, urinary concentrations of albumin, transferrin and type IV collagen, and creatinine clearance (Ccr). Then, the correlation between serum CysC levels and high-sensitivity C-reactive protein (H-CRP) levels were examined. When the patients were classified by renal function, 19% of the patients were free from nephropathy, 49% had microalbuminuria, 28% had persistent proteinuria, and 4% had end stage renal disease. The serum CysC levels increased with the progression of nephropathy, and significantly higher in overt nephropathy, but not significant in early nephropathy. Serum CysC levels were well-correlated with H-CRP levels in the patients without nephropathy. These results indicate that serum CysC would be practical for the evaluation of renal function in diabetic patients with overt nephropathy but not early nephropathy and might be related with a risk for cardiovascular events in patients without nephropathy.     

Serum cystatin C level is a good prognostic marker in patients with cirrhotic ascites and normal serum creatinine levels

Background/Aims: Serum creatinine (Cr) is not a reliable marker for early detection of renal dysfunction in patients with cirrhotic ascites. Several reports have suggested that cystatin C (CysC) is more sensitive than Cr for detecting reduced renal function in these patients. This study evaluated the clinical significance of CysC in patients with cirrhotic ascites and a normal serum Cr level. Methods: We enrolled patients with ascites and a normal serum Cr level (<1.2 mg/dl). Liver function tests, international normalized ratio (INR) and serum Cr and CysC levels were measured on the same day for all patients. CysC levels were measured using the automated latex‐enhanced immunonephelometric method. The endpoint of follow‐up was the development of hepatorenal syndrome (HRS) or mortality. Results: Seventy‐eight patients with cirrhotic ascites were enrolled in the study (58 men and 30 women; age, 53±11 years). The underlying liver diseases in these patients were chronic hepatitis B (37%), chronic hepatitis C (4%), alcoholic liver disease (53%) and others (6%). Forty‐six (59%) and 32 (41%) patients were in Child–Pugh classes B and C respectively. HRS developed in 14 patients during the follow‐up period (349±241 days), with cumulative incidences of 10.2% and 20.4% at 6 and 12 months respectively. The CysC level was the only independent predictive factor for HRS. Twenty‐three patients died during the follow‐up period. CysC level and INR were independent factors for predicting mortality. Conclusion: Serum CysC level is a good marker for predicting HRS and survival in patients with cirrhotic ascites and a normal Cr level.     

氯沙坦对伴有微量蛋白尿的老年高血压患者的影响

目的　观察氯沙坦对伴有微量蛋白尿（ ＭＣＡ） 的老年高血压患者改善肾损害的作用。　方法　采用连续样本,自身前后及分组对照方法,对３２ 例高血压伴ＭＣＡ 者（ＥＨ 组） ,男２４ 例,女８ 例,平均年龄（７１－６ ±６－８）岁,观察在治疗前和每天服用氯沙坦５０ ｍ ｇ １２ 周后的血压、血尿素氮（ＢＵＮ） 、血肌酐（Ｃｒ） 、２４ｈ 内生肌酐清除率（Ｃｃｒ） 、尿白蛋白／ 肌酐（Ａｌｂ／Ｃｒ） 的变化,ＥＨ 组治疗前在ＢＵＮ、Ｃｒ 、Ｃｃｒ 方面与１２ 例非高血压老人作对照（ 对照组） 。　结果　治疗前ＥＨ 组的Ｃｃｒ 水平较对照组明显降低（ Ｐ＜ ０－０５） ,用氯沙坦治疗后,除血压有明显下降外,尿Ａｌｂ／Ｃｒ 亦显著性降低（ Ｐ＜ ０－０１） ,Ｃｃｒ 明显升高（ Ｐ＜ ０－０５） 。　结论　氯沙坦对老年高血压患者不仅有良好的降压效果,同时可降低尿白蛋白的排泄,改善肾功能