比较血清胱抑素C及肌酐对肝肾综合征的诊断价值

目的比较血清胱抑素C（CystatinC，cys-C）和血肌酐（Scr）在肝硬化失代偿期肾损伤及疾病预后等方面的诊断效能。方法选择肝硬化失代偿期患者82例，测定CysC、Scr及肌酐清除率（Ccr），设定临界Ccr值，比较不同Ccr水平Scr及Cys-C的差别，通过ROC曲线分析比较两项指标的诊断效能。随访12个月，比较不同初始Ccr值患者病死率以及不同结局的患者初始CysC、Scr值。结果①以Ccr〈60mL／min为临界值进行分组，A组（Ccr≥60mL／min）40例，B组（Ccr〈60mL／min）42例，两组初始血肌酐值差异不显著，Cys-C值B组显著高于A组，ROC曲线分析提示Cys-CAUC值显著大于Scr；②随访病例74例，全因死亡18例，B组病死率显著高于A组。死亡患者初始Scr及Cys-C均显著高于对照组。结论CysC能更准确的反映肝硬化患者肾小球滤过功能，并且与患者预后有更高相关性，对肝硬化早期肾损害有较高诊断价值。

A Trial to Compare Serum Cys-C with Serum Creatinine in the Diagnosis of Hepatorenal Syndrome

Objective To compare serum Cys-C with Scr in the assessment of early kidney injury and prognosis for the decompensated cirrhotic patients. Method Recruit decompensated cirrhotic patients in ours hospital, examine their serum Cys-C with Scr and calculate the creatinine clearance rate.Define a critical value and compare the average serum Cys-C and Scr values in certain Ccr range.Follow up the cases for 12 months, compare the mortality between groups and their initial serum Cys-C and Scr value.Result ①82 cases were recruited, Ccr〈60mL/min was defined as the critical value and the cases were grouped .Consequently group A （Ccr t〉 60mL/min）possess 40 cases and group B（Cct〈60mL/min）42 cases.Their initial Scr had no significant difference while the Cys-C value of group B was significantly higher than that of group A .For ROC curve analysis, Cys-C showed bigger AUC value than Scr; ②74 cases had finished the follow-up study while 18 cases died.The mortality of group B were higher than those of group A.Meanwhile, significantly higher Scr and Cys-C were shown in the case who were dead and the difference of Cys-C between the groups was especially obvious. Conclusion Serum Cys-C makes more accurate reflex of GFR for cirrhotic patients than Scr. It shows high relativity with the prognosis and high diagnostic value for the early kidney injury for cirrhotic patients.