摘要
目的探讨半胱氨酸蛋白酶抑制剂C（Cystatin C）在预测和诊断心脏术后急性肾损伤（AKI）中的价值。方法前瞻性收集我院132例接受心肺旁路手术的病人，每位病人术前及术后每天采集血标本。同时应用酶法测血清肌酐（Scr），用颗粒增强透射免疫比浊法（PETIA）检测血清Cystatin C，用MDRD公式估算肾小球滤过率（eGFR）。AKI运用ADQI的RIFLE标准进行诊断（R：Scr升高≥50％基础值，I：Scr升高≥100％基础值，F：Scr升高≥200％基础值，L：肾功能丧失；E：终末期肾脏病）；同时AKI也按Cystatin C≥50％、≥100％和≥200％的标准进行诊断。结果29（21．9％）例病人发生不同程度AKI，其中10例经历R标准，12例经历I标准，7例经历F标准。其余103例没有发生AKI的病人作为对照组。AKI病人的Cystatin C较非AKI病人显著升高（P〈0．001），AKI病人的Cystatin C与Scr（r=0．732．P〈0．001）、[Cystatin C]^-1与eGFR（r=0．803，P〈0．001）成明显线性相关。分别按照Cystatin C和Scr两种方法诊断AKI，不同程度AKI诊断的中位时间是：R标准的10例病人分别为2d（1--4d）和3d（2～5d）（P=0．014），I标准12例病人分别为3．5d（1--6d）和5d（2～8d）（P=0．008），F标准7例病人分别为5d（3～7d）和6．5d（4--9d）（P=0．02）。ROC分析证实Cystatin C在AKI诊断中的准确性高（曲线下面积为0．992）。当以Cystatin C升高≥50％作为AKI的诊断截点时，Cystatin C在AKI诊断中的敏感性和特异性分别为92％和95％。结论Cystatin C可作为心肺旁路手术后AKI的诊断指标：Cystatin C在AKI的诊断时间上较Scr早，它可能作为AKI的早期预测指标之一。
Objective To prospectively study the value ofcystatin C in diagnosis of acute kidney injury （AKI） in patients after cardiac surgery. Methods A total of 132 patients undergoing cardiopulmonary bypass were enrolled in this prospectively study. From each patient, blood samples were collected everyday before and after operation to detect the serum creatinine （Scr） and cystatinC levels by enzymatic method and particle-enhanced turbidimetric immunoassay （PETIA）, respectively, and the glomerular filtration rate （eGFR） was estimated using MDRD equation. AKI diagnosis was made according to the RIFLE criteria of the Acute Dialysis Quality Initiative （ADQI） （R： Scr increased by ≥50%; I： Scr increased by ≥ 100%; F： Scr increased by ≥200%; L： Loss of kidney function; E： End-stage renal disease）. Another AKI diagnostic criterion was also adopted according to the levels of cystatin C increment, namely an increase by ≥ 50%, ≥100%, and ≥1200%. Results Twenty-nine patients （21.9%） developed AKI of varied severities, including 10 meeting the R-criteria, 12 the I-criteria, 7 the F-criteria, with the other 103 patients without AKI serving as the control group. Cystatin C of the 29 AKI patients was drastically increased in comparison with that of the control group （P〈0.001）. Significant linear correlation was found between cystatin C and Scr （r=0.732, P〈0.001） and between [cystatin C]-1 and estimated GFR （R=0.803, P〈0.001）. By the two diagnostic criteria based on cystatin C and Scr levels, respectively, the median diagnostic time of AKI was 2 days （range 1-4 days） and 3 days （range 2-5 days） for R criteria （10 patients, P=0.014）, 3.5 days （range 1-6 days） and 5 days （range 2-8 days） for I criteria （12 patients, P=0.008）, and 5 days （range 3-7 days） and 6.5 days （range 4-9 days） for F criteria （7 patients, P=0.02）, respectively. ROC analysis confirmed excellent accuracy of cystatin C in AKI diagnosis （AUC=0.992）. With the cut-off value of cystatin C increment by ≥50%, the diagnostic sensitivity and specificity of AKI was 92% and 95%, respectively.Conclusion Cystatin C can serve as a good indicator for AKI diagnosis to allow earlier detection of AKI than Scr-based diagnosis in patients after cardiac surgery.
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2008年第12期2154-2156,共3页
Journal of Southern Medical University
基金
广东省科技计划项目(2007B031503004)
