血清半胱氨酸蛋白酶抑制剂C早期诊断梗阻性黄疸患者肾功能损伤的临床研究

目的：探讨检测血清半胱氨酸蛋白酶抑制剂（cystatin C,Cys C）对早期诊断梗阻性黄疸患者肾功能损害的意义。方法：测定84例梗阻性黄疸患者的24h肌酐清除率（24h CCr）,血清肌酐（SCr）以及血清Cys C水平,并以CCr〈80mL.min-1.1.73m-2作为肾功能损害诊断标准,采用χ2检验、相关性分析和ROC曲线分析Cys C的诊断价值。结果：84例患者中共31例出现CCr下降,其中Cys C水平有26例上升,而仅有18例SCr出现异常。Cys C对CCr的评估效能优于SCr（P〈0.05）,相关性分析提示在梗阻性黄疸患者中,Cys C与SCr和CCr均有显著负相关性（CysC：r=-0.801,P〈0.001;SCr：r=-0.594,P〈0.001）。ROC曲线分析显示Cys C的曲线下面积（AUC）值明显高于SCr（0.841比0.622）。结论：Cys C较SCr能更为准确和迅速地反映梗阻性黄疸患者的肾功能损害;常规监测该类患者的Cys C水平,对有效防治梗阻性黄疸导致的急性肾功能衰竭具有积极意义。

Diagnostic Value of Serum Cystatin C for Detection of Renal Injury Early in Patient with Obstructive Jaundice

Objective：To investigate the diagnostic value of serum Cystatin C（Cys C） for detection of renal injury early in patient with obstructive jaundice.Methods： The 24 hours Creatinine Clearance（CCr）,serum level of Cys C and serum Creatinine（Scr） were measured in 84 patients with obstructive jaundice（OJ）.Chi-Square2 test,Pearson correlation test as well as ROC curve were utilized to evaluate the diagnostic significance of Cys C.Results： Thirty-one of 84 OJ patients showed the renal injury.Among these 31 patients,26 cases had elevated the level of Cys C,whereas 18 cases had elevated level of SCr.Cys C and SCr both significantly inversely correlated with CCr（CysC： r=-0.868,P0.001;SCr：r=-0.604,P0.001）,However,coefficient of Cyst C to CCr was obviously higher than that of SCr.Moreover,using ROC curve,Cys C was diagnostically superior to SCr area under the curve（AUC） for cystatin C 0.841,;AUC for creatinine 0.822].Conclusions： Cys C is a more accurate and sensitive marker of renal injury in OJ patients.Detection of Cys C level in OJ patients could contribute to the treatments of OJ.