血清胱抑素 C 水平对重型颅脑损伤患者急性肾损伤的预测价 值简

目的分析血清胱抑素C（Cys—C）水平对重型颅脑损伤合并急性肾损伤患者的诊断及预后评估价值。方法选取2010年1月～2012年12月右江民族医学院附属医院急性颅脑损伤患者212例为研究对象，将伤后48h内出现肾损伤（AKI）患者纳入观察组（61例），未出现AKI患者为对照组（151例），比较两组患者血清Cys—C水平差异，ROC曲线评价血清Cys—C诊断AKI的准确度，比较观察组中不同肾功能分级患者Cys—C的差异及预后转归。结果①观察组血清Cys—C、BUN、Scr水平（2．81±0．83）mg／L、（9．02±2．64）mmol／L、（254．8±120．1）μmol／L]明显高于对照组（1．01±0．24）mg／L、（6．10±1．07）mmol／L、（87．8±12．6）μmol／L]，差异有统计学意义（P〈0．05）；而观察组eGFR水平（36．5±24．2）mL／（min·1．73m2）]显著低于对照组（76．2±19．7）mL／（min·1．73m2）]，差异有统计学意义（P〈0．05）。②血清Cys—C、BUN、Ser诊断AKI的ROC曲线下面积分别为0．967、0．86l、0．905，Cys—C的ROC曲线面积明显高于BUN、Scr，差异有统计学意义（P〈0．05）。⑧观察组中AKI、2、3期分别为20、17、24例，不同AKI分期患者Cys—C、BUN、SCr、eGFR水平以及死亡率比较，差异有统计学意义（P〈0．05），且AKI患者血清Cys—C与Scr呈正相关（r=0．836，P〈0．01），Cys—C与eGFR呈负相关（r=-0．812，P〈0．01）。结论血清Cys—C可作为重型颅脑损伤患者发生AKI的诊断指标，相对于Scr、BUN等指标敏感性、特异性更高，在AKI早期诊断、预后评估具有一定的应用价值。

Prognosis value of serum Cystatin C for the acute kidney injury in pa- tients with severe traumatic brain injury

Objective To analyze the prognosis value of level of serum Cystatin C （Cys-C） for the acute kidney injury （AKI） in patients with severe traumatic brain injury. Methods 212 patients with acute severe traumatic brain injury were collected from January 2010 to December 2012 in Affiliated Hospital of Youjiang Medical College for Nationali- ties. 61 patients who suffered AKI in 48 h were taken into observation group and the patients without AKI were chosen as control group. Comparison was made in the level of serum Cys-C between two groups. The diagnostic accuracy was evaluated by the receiver operator characteristic curve （ROC curve）. The level of serum Cys-C and prognosis in pa- tients with different AKI stage were observed. Results ①The level of serum Cys-C, BUN, Scr in observation group （2.81±0.83） mg/L, （9.02±2.64） mmol/L, （254.8±120.1） μmol/L] were higher than control group （1.01±0.24） mg/L, （6.10±1.07） mmol/L, （87.8±12.6） μmol/L], while the eGFR in observation group （36.5±24.2） mL/（min. 1.73 m2）] was lower than that in control group （76.2±19.7） mL/（min. 1.73 m2）], the difference was statistically significant （P 〈 0.05）. ②The ROC area of Cys-C,BUN, Scr were 0.967, 0.861, 0.905 respectively, and the ROC area of Cys-C were higher than BUN and Scr, the differences were statistically significant （P 〈 0.05）. ③20 patients were in 1 st stage of AKI, 17 patients were in 2nd stage and 24 patients were in 3rd stage. The levels of Cys-C, BUN, SCr, eGFR and death rate were obvi- ous differences in patients with different AKI stage （P 〈 0.05）. According to linear correlation analysis, serum Cys-C was positively correlated with Scr （r = 0.836, P 〈 0.01）, but the negative correlation was found with eGFR （r = -0.812, P 〈 0.01）. Conclusion Compared with Scr and BUN, serum Cys-C is more sensitively and accurately reflecting the decline of renal function in patients with severe traumatic brain injury, and it is a good diagnostic marker for early kidney damage.