硫酸镁治疗前后重度子痫前期孕妇血清胱抑素C水平变化的研究

目的研究重度子痫前期经硫酸镁治疗后血清胱抑素C水平变化。方法选取2011年5月-2012年12月在广州医学院附属深圳沙井医院确诊治疗的重度子痫前期病例30例纳入研究组,同期选择健康孕妇30例作为对照组,所有观察对象于硫酸镁治疗前测量外周血清胱抑素C水平,24h后重度子痫前期组再次抽血检测血清胱抑素C水平。结果 1重度子痫前期组治疗前血清胱抑素C水平为1.33±0.57mg/L,对照组为0.85±0.11mg/L,两组间比较差异有统计学意义,P〈0.05。2重度子痫前期组硫酸镁治疗后血清胱抑素C水平为1.20±0.14mg/L,较治疗前降低,差异比较有统计学意义,P〈0.05,3重度子痫前期组硫酸镁治疗后尽管血清胱抑素C水平下降,但较对照组比较,仍明显升高,差异比较有统计学意义,P〈0.05。结论重度子痫前期孕妇经硫酸镁治疗后血清胱抑素C水平下降。     

甲襞微循环及胱抑素C联合检测在子痫前期治疗中的临床意义

目的 研究在子痫前期治疗中检测甲襞微循环及胱抑素C（CC）的变化及意义。方法 选择子痫前期患者100例，随机分为50例硝酸甘油治疗作为观察组，50例硫酸镁治疗作为对照组。分别测定治疗前后血清CC浓度，甲襞微循环的变化，脐动脉收缩期与舒张期比值（S／D）及阻力指数，血压和24h尿蛋白。结果 （1）两组血清CC值及24h尿蛋自治疗后均降低，治疗前后差异有显著性（P〈0．01）。（2）观察组治疗后甲襞微循环及血压有显著性变化（P〈0．05）而对照组则无明显变化；（3）两组治疗前后脐动脉收缩期与舒张期比值（S／D）及阻力指数差异均有显著性（P〈0．05）。结论 （1）硝酸甘油能够改善妊娠高血压疾病患者的微循环状态及肾功能，降低血压及胎儿胎盘阻力。（2）硝酸甘油是治疗妊娠高血压疾病的良好方法，甲襞微循环与CC检测可作为子痫前期患者治疗的重要监测指标，为在产科领域广泛应用提供了理论依据。     

维吾尔族早发型子痫前期患者血清晚期氧化蛋白产物和胱抑素C水平及其与妊娠结局的相关性

目的:探讨血清晚期氧化蛋白产物(Advanced oxidation protein products,AOPP)以及胱抑素C(Cystatin C,CysC)与维吾尔族早发型子痫前期的妊娠结局的相关性。方法:分析2011年5月至2013年5月在我院妇产科接受治疗且分娩的75例维吾尔族早发型子痫前期患者的临床资料,对照组为同期在我院接受产前检查的60例维吾尔族正常孕妇。比较子痫前期患者与正常对照组的AOPP及Cys-C水平差异,并对不同严重程度、不同妊娠结局的早发子痫前期患者的临床资料、不良妊娠结果(包括子痫、羊水过少、胎儿窒息、胎盘早剥、胎儿生长受限、HELLP综合征等)进行比较。结果:本研究共纳入维吾尔族孕妇135例,其中子痫前期患者75例(包括轻度组35例,重度组40例),正常对照组孕妇60例。子痫前期患者的SBP(t=3.410,P<0.01)、Cys-C(t=4.586,P<0.01)、AOPP(t=7.980,P<0.01)水平均显著高于正常对照组;轻度组患者的SBP(t=3.992,P<0.01)、Cys-C(t=4.126,P<0.01)、UA(t=4.817,P<0.01)、Cr(t=7.848,P<0.01)、AOPP(t=6.540,P<0.01)值均显著低于重度组;轻度组患者出现羊水过少(χ2=4.688,P=0.030)、胎盘早剥(χ2=5.195,P=0.023)、胎儿生长受限(χ2=7.252,P<0.01)、HELLP综合征(χ2=4.688,P=0.030)的概率均低于重度组,差异均具有统计学意义;结局不良组患者的Cys-C(t=5.234,P<0.01)、尿酸(t=3.337,P<0.01)、Cr(t=3.745,P<0.01)、AOPP(t=6.540,P<0.01)水平均显著高于良好组。结论:维吾尔族早发子痫前期患者的Cys-C水平明显上升,且Cys-C及AOPP水平与患者的妊娠结局有着重要的相关性。     

冠心病患者血清超敏C反应蛋白及胱抑素C水平分析

目的:分析冠心病(CHD)患者血清超敏C反应蛋白(hs-CRP)和胱抑素C(Cys-C)水平变化。方法:125例CHD患者分为急性心肌梗死组(AMI组,n=24)、不稳定性心绞痛组(UA组,n=73)、稳定性心绞痛组(SA组,n=28),同期因胸闷、胸痛症状经冠状动脉造影排除CHD的患者作为对照组(n=80)。采用免疫比浊法测定各组血清hs-CRP和Cys-C浓度,统计分析各组间差异及二者单检和联检对CHD的诊断效能。结果:CHD各组血清hs-CRP和Cys-C水平均高于对照组,差异有统计学意义(P0.01)。血清hs-CRP和Cys-C诊断CHD的ROC曲线下面积分别为0.70(95%CI:0.63-0.77)和0.72(95%CI:0.66-0.79),二者联合检测诊断CHD的ROC曲线下面积为0.76(95%CI:0.70-0.83)。以4.23mg/L为Cut-off值,血清hs-CRP诊断CHD的灵敏度为82.40%,特异度为53.70%;以1.37mg/L为Cut-off值,血清Cys-C诊断CHD的灵敏度为77.70%,特异度为60.20%;二者联合检测的灵敏度和特异度分别为84.30%和65.40%。结论:hs-CRP和Cys-C水平与CHD的发生发展有关,二者血清水平联合检测可以提高CHD诊断的灵敏度和特异度。     

同型半胱氨酸和胱抑素C对先兆子痫的预测价值

目的 研究同型半胱氨酸(Hcy)和胱抑素C(Cys C)对先兆子痫的预测价值.方法 检测60名先兆子痫孕妇和正常孕妇在孕第15至16周的Hcy水平.采用受试者工作特征(ROC)曲线分析法评价Hcy和Cys C对先兆子痫的预测价值,分析Hcy和Cys C与先兆子痫发生时间的关系.结果 发生先兆子痫的孕妇在第15至16周的Hcy和Cys C水平显著高于正常孕妇.Hcy和Cys C预测先兆子痫的ROC曲线下面积分别为0.79和0.75.Hcy和Cys C水平越高,患者发生先兆子痫的时间越早.结论 妊娠第15至16周的Hcy和Cys C水平可以预测先兆子痫的发生.     

急性心肌梗死患者血清胱抑素C、同型半胱氨酸水平变化及其相关性

目的:检测分析急性心肌梗死(AMI)患者血清胱抑素C(CysC)、同型半胱氨酸(Hcy)水平变化及CysC与Hcy的相关性。方法:158例临床诊断为AMI患者作为AMI组,160例健康体检者为对照组,平行检测血清CysC和Hcy水平,并分析AMI患者CysC与Hcy之间的相关性。结果:AMI患者血清CysC水平低于对照组,Hcy水平明显高于对照组,差异有统计学意义(P均<0.01);AMI患者CysC水平与Hcy无显著相关性(r=0.068,P>0.05)。结论:AMI患者早期CysC水平明显降低。     

冠心病患者血清同型半胱氨酸与胱抑素C水平的相关性分析

目的 探讨冠心病患者血清同型半胱氨酸（Hcy）与胱抑素C（CysC）水平的变化及其临床意义.方法 选取218例冠心病患者与129例健康对照者,分别检测其血清Hcy与CysC水平,并进行比较与分析.结果 冠心病组的血清Hcy与CysC水平显著高于对照组（P＜0.01）,且其阳性率显著高于对照组（P＜0.01）,而联合检测的阳性率显著高于单项检测（P＜0.01）;血清Hcy与CysC对冠心病诊断有较高的特异度（分别为92.2％与97.7％）与阳性预测值（分别为89.2％与96.1％）,而灵敏度（分别为38.1％与33.9％）与阴性预测值（分别为46.9％与46.7％）不高,联合并联检测可显著提高诊断灵敏度至51.8％;血清Hcy水平与CysC水平正相关（r=0.363,P＜0.01）.结论 Hcy、CysC水平与冠心病关系密切,联合检测对于冠心病患者的诊断、治疗及预后具有重要临床意义.     

血清胱抑素C对冠心病患者预后评估的价值

目的：探讨血清胱抑素C水平对冠心病患者预后评估中的作用。方法：选择住院且经冠脉造影等检查确诊的冠心病患者共142例,其中不稳定性心绞痛患者72例,稳定性心绞痛患者70例,并选造影正常者65例作为对照,用免疫比浊法测定血清胱抑素C浓度,对所有患者随访1年,记录主要心血管不良事件发生情况。统计分析血清胱抑素C与主要心血管不良事件的关系。结果：冠心病患者血清胱抑素C水平与主要不良心血管事件(major adverse cardiac vascular events,MACE)总事件相关,相关系数r值为0.43(P<0.05)。结论：血清胱抑素C水平可作为预测冠心病患者MACE事件的一个评价指标。     

血清胱抑素C水平与冠心病关系的Meta分析

目的 综合评价血清胱抑素C(CysC)与冠心病的关系,旨在为冠心病的预防和诊治提供循证医学证据.方法 计算机检索SinoMed、ScienceDirect、Embase、Pubmed关于CysC与CHD相关性的研究,搜索时间为自建库至2015年.由两名独立的评价人员根据纳入和排除标准,筛选文献,提取数据.采用Review Manager 5.3软件进行Meta分析.绘制倒漏斗图,行Begg's和Egg's检验,判定发表偏倚的可能性.逐一剔除纳入研究,绘制敏感性分析图,进行敏感性分析.结果 纳入研究10个,患者977例.Meta分析结果:以队列研究组为对象,与对照组比较,冠心病组[SMD=1.51,95％CI(1.20,1.82)]的CysC水平明显升高,差异显著有统计学意义(Z=9.51,P＜0.05);以病例对照研究组为对象,与对照组比较,冠心病组[SMD=3.27,95％ CI(2.95,3.60)]的CysC水平明显升高,差异显著有统计学意义(Z=19.92,P＜0.05);纳入研究倒漏斗图呈对称分布,Begg's和Egg's检验P值分别为0.72和0.88,提示研究间存在发表的可能性小.结论 高水平的血清CysC与CHD密切相关.     

代谢综合征患者血清同型半胱氨酸与胱抑素C水平检测的临床意义

目的测定代谢综合征(MS)患者血清同型半胱氨酸(homocysteine,HCY)、胱抑素C(cystatin,CysC)的水平,探讨二者对代谢综合征患者的临床意义。方法随机收集代谢综合征患者血清30例,对照组血清32例。测定两组血清HCY、CysC的水平,并分析代谢综合征组HCY与CysC的相关性。结果代谢综合征组的血清HCY、CysC水平均较对照组升高且有统计学意义(P0.05),并且代谢综合征组血清CysC与HCY呈正相关(r=0.652,P0.01)。结论血清HCY和CysC水平均为可反映代谢综合征病情的较为敏感、准确、可靠的指标,两者联合检测对代谢综合征患者在诊断、治疗、病情监测上有一定的临床意义。     

窒息新生儿血清胱蛋白酶抑制剂C检测及意义

目的探讨窒息新生儿血清胱蛋白酶抑制剂C（Cys C）水平在评价新生儿窒息后肾损害的意义。方法以68例窒息新生儿为研究对象,按Apgar评分分为轻度窒息组（47例）和重度窒息组（21例）;以40例健康足月新生儿作为对照组,在入院后抽取外周静脉血3mL,检测各组血清Cys C水平,并与血清尿素氮（BUN）、肌酐（Cr）等指标进行相关性分析。采用SPSS 10.0软件进行多因素方差分析和χ2检验比较其差异。结果在对照组、轻度窒息组和重度窒息组中,血清Cys C水平分别为（0.85±0.31）mg/L,（1.77±0.37）mg/L和（2.61±0.47）mg/L,血清BUN水平分别（4.61±1.16）mmol/L、（6.58±1.33）mmol/L和（8.73±2.67）mmol/L,血清Cr水平分别为（48.51±12.89）μmol/L,（49.93±14.62）μmol/L和（71.36±13.33）μmol/L,与对照组及轻度窒息组相比,重度窒息组血清BUN、Cr和Cys C水平显著升高,差异有显著性（P〈0.01）。三组之间对比Cys-C均有显著统计学意义,而BUN和Cr在对照组与轻度窒息组间差别无显著性。结论 Cys C是评价新生儿窒息后肾小球滤过功能损害的敏感指标。     

Serum cystatin C level is a useful marker for the evaluation of renal function in patients with cirrhotic ascites and normal serum creatinine levels

Background/Aims

Several studies suggested that serum cystatin C (CysC) is more useful than serum creatinine (Cr) for the assessment of renal function in patients with liver cirrhosis. This study evaluated the clinical significance of CysC in patients with cirrhotic ascites and normal Cr level.

Methods

We enrolled patients with cirrhotic ascites and a normal serum Cr level (<1.2 mg/dL). GFR was measured by ^99mTc-DTPA renal scan. Serum Cr, CysC, and Cr clearance (CCr) were measured on the same day. Significant renal impairment and severe renal impairment were defined as GFR <60 mL/min and GFR <30 mL/min, respectively.

Results

Eighty-nine patients with cirrhotic ascites were enrolled in the study (63 men and 26 women; age, 55±11 years). Forty-seven (52.8%) and 42 (47.2%) patients were in Child-Pugh grade B and C, respectively. Serum Cr and CysC levels and GFR were 0.8±0.2 mg/dL, 1.1±0.3 mg/L, and 73.4±25.5 mL/min, respectively. Significant and severe renal impairment were noted in 28 (31.5%) and 2 (2.2%) patients, respectively. GFR was well correlated with serum Cr, CysC, and e-GFR_MDRD, while it was not correlated with e-GFR_C&G. In multivariate analysis, only CysC was significantly correlated with GFR (β, 45.620; 95% CI, 23.042-68.198; P<0.001). Serum CysC level was the only independent predictor for significant renal impairment.

Conclusions

Significant renal dysfunction was not rare in patients with cirrhotic ascites, even their serum Cr level is normal. Serum CysC is a useful marker for detecting significant renal dysfunction in these patients.     

血胱蛋白酶抑制剂C在监测窒息新生儿早期肾功能损伤中的应用

目的探讨血胱蛋白酶抑制剂C（Cystatin C）在窒息新生儿中的变化及意义,评价其在窒息新生儿早期肾功能损伤中的应用。方法按Apgar评分标准将观察对象分为正常对照组、轻度窒息和重度窒息组。入选新生儿生后48h～72h间采集标本测定血：胱蛋白酶抑制剂C、Cr、CCr及BUN,并进行分析观察。结果正常对照组50例,轻度窒息140例,重度窒息60例。（1）窒息新生儿的血胱蛋白酶抑制剂C,BUN及Cr显著高于正常对照组（P〈0.01）;重度窒息组血胱蛋白酶抑制剂C,BUN及Cr高于轻度窒息（P〈0.01）。（2）有少尿症状的窒息新生儿中测定血胱蛋白酶抑制剂C较Scr,BUN灵敏。（3）血胱蛋白酶抑制剂C推算GFR与内生肌酐清除率相关性好。结论血胱蛋白酶抑制剂C可以反应窒息新生儿肾功中的早期损害,其敏感性优于BUN及Cr;并且血胱蛋白酶抑制剂C可较精确计算GFR。     

Diagnostic value of cystatin C for predicting acute kidney injury in patients with liver cirrhosis

Background/Aims

The present study aimed to determine the role of cystatin C as a prognostic factor for acute kidney injury and survival in cirrhotic patients.

Methods

The study investigated 53 liver cirrhosis patients. The renal function was evaluated by serum creatinine, serum and urine cystatin C, and 24-hour creatinine clearance on admission. Acute kidney injury was defined as a serum creatinine level exceeding the normal range (>1.2 mg/dl) and an increase of at least 50% from the baseline value. Multivariate analysis, receiver operating characteristic curve, and survival analysis were used to investigate prognostic factors for acute kidney injury and survival.

Results

Nine of the 53 cirrhotic patients (17.0%) developed acute kidney injury within 3 months. Both serum creatinine and cystatin C were predictive factors for acute kidney injury in univariate analysis, with a diagnostic accuracy of 0.735 (95% confidence interval (CI), 0.525-0.945; p=0.028) for serum cystatin C and 0.698 (95% CI, 0.495-0.901, p=0.063) for creatinine. In multivariate analysis, only serum cystatin C was an independent risk factor for acute kidney injury. The sensitivity and specificity of a serum cystatin C level of >1.23 mg/L to acute kidney injury were 66% and 86%, respectively. Serum cystatin C was positively correlated with the Model for End-Stage Liver Disease (MELD) and MELD-Na scores (r=0.346 and p=0.011, and r=0.427 and p=0.001, respectively). Comparison of the survival rates over the observation period revealed that a serum cystatin C level of >1.23 mg/L was a useful marker for short-term mortality (p<0.001).

Conclusions

The accuracy in predicting acute kidney injury and short-term mortality was higher for a serum cystatin C level of >1.23 mg/L than for the serum creatinine concentration in patients with cirrhosis.     

Clinicopathologic significance of cystatin C expression in gliomas

Cathepsin B, one of the lysosomal cysteine proteases, has been related to tumor invasiveness. Cystatin C is the strongest inhibitor of cathepsin B. Knowledge of its participation in the progression of gliomas is limited. We investigated the expression of cystatin C and its association with the clinicopathologic features of 57 gliomas. Cystatin C and cathepsin B expressions were evaluated by immunohistochemical methods and by semiquantitative real-time polymerase chain reaction analysis for the corresponding messenger RNA. Disease-free survival was analyzed by the Kaplan-Meier method. Tumors with low cystatin C protein expression and high cathepsin B protein expression were significantly more likely to be of high grade, and this pattern was significantly correlated with high Ki-67 LI and tumor recurrence. Depressed expression of cystatin C messenger RNA in glioblastomas compared with low-grade astrocytomas was demonstrated. Multivariate analysis demonstrated high tumor grade, high Ki-67 labeling index, high cathepsin B expression, and low cystatin C expression correlated significantly with shorter disease-free survival. These results suggest that gliomas in patients with an unfavorable clinical outcome are characterized by depressed expression of cystatin C. Evaluation of cystatin C expression in gliomas provides useful clinical information, especially as a prognostic indicator.     

定量检测血和尿中Cystatin C含量在肾移植患者肾功能评价中的应用

目的:建立定量检测半胱氨酸蛋白酶抑制剂C(cys C)水平的夹心ELISA方法,对肾移植患者的肾功进行监测,以期作为术后急性排斥反应(AR)及肾功能延迟恢复(DGF)发生的一项新的预警指标.方法:建立分泌抗人cys C单克隆抗体(mAb)的杂交瘤细胞株,制备腹水纯化mAbs并进行辣根过氧化物酶标记,建立检测cys C的夹心ELISA方法;应用此方法检测正常人及23例肾移植患者移植手术前后的血清(scys C)及尿(IJcys C)标本中cys C的含量并分析其与血清肌酐(SCR)的相关性.结果:获得7株可稳定分泌抗cys CmAb的杂交瘤细胞.应用建立的ELISA方法检测cys C含量敏感度可达O.1ug/L.肾移植正常恢复(NC)组患者Scys C及Ucys C含量与SCR下降趋势一致.术后发生AR的患者Ucys C水平持续较高,直到术后21 d才出现下降.而发生DGF的患者同NC组患者相比术后4周内Scys C及Ucys C与SCB维持在较高水平,Ucys C的水平有逐渐升高的趋势,直到术后60 d才下降到与NC相近的水平.结论:建立了敏感稳定的检测cys C含量的ELISA方法,可用于检测Ucys C水平.而Scys C及Ucys C的持续升高可能提示肾移植患者术后AR或DGF的发生.     

Gingival crevicular fluid and serum cystatin c levels in periodontal health and disease

Cystatin C (CSTC) is an inhibitor of cysteine proteinases and could play a protective and regulatory role under inflammatory conditions. The present study was designed to assess the concentration of CSTC in gingival crevicular fluid (GCF) and serum, to find out their association if any, in periodontal health and disease. 30 subjects were selected divided into 3 groups consisting of 10 subjects in each group based on clinical parameters: periodontally healthy group, gingivitis group and chronic periodontitis group, while, chronic periodontitis group after 8 weeks of the treatment (scaling and root planing) constituted after periodontal therapy group. GCF and serum samples were collected from all subjects to estimate the levels of CSTC by ELISA. The mean CSTC concentration in GCF and serum was observed to be the highest in periodontitis group and lowest in periodontally healthy group with intermediate concentration in gingivitis group and after periodontal therapy group. CSTC concentration in GCF and serum increased proportionally with the severity of periodontal disease (from health to periodontitis group) and decreased after treatment. This suggests that CSTC increases with disease progression to prevent further periodontal degeneration and decreases after treatment due to bone metabolic homeostasis. Further, longitudinal prospective studies involving larger population are needed to confirm the findings of present study and to better understand the role of CSTC in the pathogenesis of periodontal diseases.     

Serum cystatin C is a sensitive early marker for changes in the glomerular filtration rate in patients undergoing laparoscopic surgery

OBJECTIVE:

Pneumoperitoneum during laparoscopy results in transient oliguria and decreased glomerular filtration and renal blood flow. The presence of oliguria and elevated serum creatinine is suggestive of acute renal injury. Serum cystatin C has been described as a new marker for the detection of this type of injury. In this study, our aim was to compare the glomerular filtration rate estimated using cystatin C levels with the rate estimated using serum creatinine in patients with normal renal function who were undergoing laparoscopic surgery.

METHODS:

In total, 41 patients undergoing laparoscopic cholecystectomy or hiatoplasty were recruited for the study. Blood samples were collected at three time intervals: first, before intubation (T1); second, 30 minutes after the establishment of pneumoperitoneum (T2); and third, 30 minutes after deflation of the pneumoperitoneum (T3). These blood samples were then analyzed for serum cystatin C, creatinine, and vasopressin. The Larsson formula was used to calculate the glomerular filtration rate based on the serum cystatin C levels, and the Cockcroft-Gault formula was used to calculate the glomerular filtration rate according to the serum creatinine levels.

RESULTS:

Serum cystatin C levels increased during the study (T1 = T2<T3; p<0.05), whereas serum creatinine levels decreased (T1 = T2>T3; p<0.05). The calculated eGlomerular filtration rate-Larsson decreased, whereas the eGlomerular filtration rate-Cockcroft-Gault increased. There was no correlation between cystatin C and serum creatinine. Additionally, Pearson''s analysis showed a better correlation between serum cystatin C and the eGlomerular filtration rate than between serum creatinine and the eGlomerular filtration rate.

CONCLUSION:

This study demonstrates that serum cystatin C is a more sensitive indicator of changes in the glomerular filtration rate than serum creatinine is in patients with normal renal function who are undergoing laparoscopic procedures.