急性中毒患者血清视黄醇结合蛋白和胱抑素C联合检测的临床意义

摘要

目的:探讨急性中毒患者血清视黄醇结合蛋白(RBP)和胱抑素C(Cys-C)联合检测对早期肝肾功能不全的诊断价值.方法:选取113例不同类型的急性中毒患者,于中毒第1、3天分别测定血清RBP、丙氨酸氨基转移酶 (ALT)、天门冬氨酸氨基转移酶 (AST)、清蛋白 (ALB)、前白蛋白(PA)、尿素氮(BUN)、肌酐(Scr)和Cys-C,对照组为37位健康人.结果:急性中毒组血清RBP、PA、ALB均显著低于对照组(P<0.01),血清Cys-C、BUN、Scr、ALT和 AST则显著高于对照组(P<0.01),且各检测指标水平在中毒第1、3天均有统计学差异( P< 0.05).急性中毒患者在中毒第1天肾功能不全的血Cys-C阳性检出率高达48.2%,肝功能不全的血RBP阳性检出率高达47.7%.结论:血清 RBP浓度较灵敏地反映早期肝功能改变,血清Cys-C浓度也能较早地反映肾功能改变,两者联合检测对尽早发现急性中毒患者的肝肾功能不全和改善预后具有重要临床意义.%Objective: To evaluate the significance of determining serum retinal-binding protein (sRBP) and serum cystatin C (Cys-C)in acute poisoning patients for early estimation of hepatic and renal insufficiency.Methods:One hundred and thirteen patients with different kinds of acute poisoning received determination of sRBP, alanine aminotransferrase ( ALT), aspartate aminotransferase( AST), albumin ( ALB ), prealbumin (PA), blood urea nitrogen ( BUN ), serum creatinine (Scr) and Cys-C at the 1 st and 3rd day, respectively, after the accident, and 37 healthy subjects were recruited as controls. Results: The levels of sRBP, PA and ALB were significantly lower, whereas the levels of Cys-C, BUN, Scr,ALT and AST were much higher for the acute poisoning patients as compared with the controls( P ＜0.01 ). Particularly, the levels appeared different at the 1 st and 3rd day after poisoning( P ＜ 0.05 ). Positive Cys-C was detected in as many as 48.2％ of the patients with renal insufficiency, and positive sRBP was found in 47.7 ％ with hepatic insufficiency,at the 1 st day after poisoning. Conclusion:sRBP could sensitively reveal the early change of liver function and serum Cys-C may register the early variation of renal function, suggesting that combined detection of the two factors is of great clinical significance in estimating the hepatic and renal insufficiency and prognosis of the patients after acute poisoning.