胱抑素C及肌酐监测休克患者急性肾损伤的研究

目的 通过监测休克患者胱抑素C(CysC)、血清肌酐(Scr)的变化探讨各指标评估急性肾损伤的意义.方法 本前瞻性研究选取2006年2月至2007年6月在中山大学附属第一医院休克抢救的患者71例,其中男性42例,女性29例.排除有肾脏疾病史或肾功能异常等患者.所有患者根据休克时间分为4组.测定休克期间1 h,2 h,3 h,4 h和纠正休克后72 h,7 d血清CysC,Scr的值.计算患者休克后GFR下降的数值.根据Scr及计得的GFR降对患者肾损害进行分期.计算并比较各检测方法的阳性检出率,并将测得的CysC,Scr,GFR校进行统计学比较分析.相关性分析采用非参数检验的Pearson's相关系数计算.结果 4组患者休克各时点CysC升高较Scr升高早,纠正休克后CysC较Scr恢复正常值迟.在休克时间小于1 h,CysC即升高.1 h以内血清CysC,Scr均与GFR具有负相关性r值分别为-0.83,-0.57(P＜0.05),2 h,3 h,4 h相关性无统计学意义.在休克早期,以CysC和GFR的相关程度更密切.结论 休克早期患者已有肾功能损害,CysC比Scr更有利于发现1期急性肾损伤.

Study of CysC and Scr used to evaluate acute renal injury of patients with shock

Objective To investigate the roles of cystatin C (CysC) and serum creatinine (Scr) in acute renal injury of patients with shock. Method A total of 71 patients with shock, 42 male and 29 female, were enrolled from February 2006 to June 2007. Patients with kidney disease or renal insufficiency were excluded. All of patients were assigned to 4 groups as per the duration of shock. The blood samples were taken from patients for measurements of CysC and Scr during the periods of 1 hr,2 hr,and 4 hr of shock and 72 hr and 7 days after correction of shock. The corrected GFR (cGFR) and decreased GFR (dGFR) were calculated. The levels of Scr and dGFR could be used to classify the acute renal injury into stages according to the Acute Kidney Injury Diagnosis Criteria. The positive detection rates of different methods were compared. The levels of CysC, Scr and cGFR were statistically analyzed. Data were studied by using Pearson's correlation analysis, Results The elevation of CysC appeared sooner than that of Scr in all shock patients. Contrarily, the high level of CysC lowered to normal level much slower than that of SCR after correction of shock. The CysC increased 1 hour after shock. The GFR was negatively correlated with CysC and Scr, especially in the early stage of shock. Conclusions The renal dysfunction appears in the early stage of shock. The CysC assayed is more sensitive in the stage 1 of renal injury than Scr.