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叶照伟,蔡立华,沈利汉.胱抑素C在脓毒症相关的急性肾损伤中的诊断价值[J].中国医药科学,2019,(9):190-193        基金项目:广东省东莞市社会科技发展项目(2014108101024)
胱抑素C在脓毒症相关的急性肾损伤中的诊断价值
Diagnostic value of cystatin C in acute kidney injury associated with sepsis
  
DOI:
中文关键词:  急性肾损伤;胱抑素 C;脓毒症;肾小球滤过率;血肌酐
英文关键词:Acute kidney injury;Cystatin C;Sepsis;Glomerular filtration rate;Serum creatinine
作者单位
叶照伟,蔡立华,沈利汉 广东省东莞市人民医院重症医学科,广东东莞 523059 
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中文摘要:
      目的 胱抑素 C(Cys-C)对脓毒症合并急性损伤(AKI)患者的诊断价值。 方法 选取 2016 年 11月~ 2017 年 11 月我院接收的 100 例脓毒症合并急性肾损伤患者作为观察组,同时选择同期在我院就诊的脓毒症患者 100 例作为对照组,均患者于入院 2、24 及 48h 时采集患者 3mL 静脉血检测 Cys-C 水平及血肌酐(Scr)水平,并计算肾小球滤过率(GFR),采用 Pearson 相关系数进行组间的相关性描述,采用 ROC 的灵敏性特异性对指标诊断价值进行判定。 结果 观察组患者入科 24、48h 时 Scr 水平明显高于对照组,而入院2h 比较无明显差异,而 Cys-C 在上,两组患者入院 2、24 及 48h 比较差异均有统计学意义(P < 0.05);CysC1-3 与 Scr1 无相关性,Cys-C 与 Scr2-3 呈正相关(均 P < 0.05); 血清 Scr、Cys-C 与 GFR 均呈负相关(P< 0.05),而 Cys-C 与 GFR 的相关系数较 Scr 与 GFR 的相关系数更高;观察组患者 Scr1 的 ROC 曲线下面积为 0.5,其余时间点的 Scr 及 Cys-C 的 ROC 曲线下面积均在 0.8 以上。观察组入科 2h Cys-C 的 AUC 约为 0.815,Cys-C 的临界值为 1.15mg/L,Scr 的 AUC 值约为 0.546,临界值为 110μmol/L。 结论 脓毒症相关的急性肾损伤患者血 Cys-C 水平明显升高,较 Scr 可更早反映肾脏损伤,对于急性肾脏损伤的早期识别有重要意义。
英文摘要:
      Objective To explore the diagnostic value of cystatin C (Cys-C) in patients with sepsis complicated with acute kidney injury (AKI). Methods 100 patients with sepsis complicated with acute kidney injury who were admitted to our hospital from November 2016 to November 2017 were selected as the observation group.100 patients with sepsis who were treated in our hospital during the same period were selected as the control group.At 2h,24h and 48h after admission,3mL of venous blood was collected to detect the level of Cys-C and serum creatinine (Scr),and the glomerular filtration rate (GFR) was calculated.Pearson correlation coefficient was used to describe the correlation between the groups,and the sensitivity and specificity of ROC were used to determine the diagnostic value of the indexes. Results The Scr level in the observation group was significantly higher than that in the control group at 24h and 48h after admission,while there was no significant difference at 2h after admission.But as for Cys-C,there were significant differences between the two groups at 2h,24h and 48h after admission (P < 0.05).There was no correlation between cys-c1-3 and Scr1, but there was positive correlation between Cys-C and Scr2-3 (P < 0.05).Serum Scr and Cys-C and were both negatively correlated with GFR (P < 0.05).The correlation coefficient between Cys-C and GFR was higher than that between Scr and GFR.The area under the ROC curve of Scr1 in the observation group was 0.5,and the area under the ROC curve of Scr and Cys-C at other time points was above 0.8.The AUC of Cys-C for 2h after admission in the observation group was about 0.815 and the critical value of Cys-C was 1.15 mg/L.The AUC value of Scr was about 0.546 and the critical value was 110μmol/L. Conclusion Blood Cys-C level is significantly increased in patients with acute kidney injury associated with sepsis,which can reflect kidney injury earlier than Scr and is of great significance for the early identification of acute kidney injury.
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