血清胱抑素C和APACHEⅡ评分系统在ICU急性肾损伤患者中的预后价值

摘要

Objective To explore the prognostic value of Serum Cystatin C and APACHEⅡ scoring systems in Intensive Care Unit patients with acute kidney injury. Methods 32 patients with AKI from June 2010 to May 2011 were collected and analyzed, which conform to the criteria for the diagnosis of AKI. Recorded its cystatin C change,at the same time collecting clinical data,including gender,age,chronic disease history, 24 h inside all sorts of assay index(routine blood, blood gas analysis, renal function, blood electrolyte,etc. ) the worst value,and carried on the APACHE Ⅱ score. AKI group were divided into live group and death groups,observing the two groups of APACHE Ⅱ score difference. In addition the same period selected 20 cases of patients in ICU which did not happen AKI as a non AKI group. Results Of the 32 cases of acute kidney injury were analyzed, 11 cases of death, mortality was 34. 4%. With the APACHE II scores increased, Serum Cystatin C levels are rising. Survival and mortality between groups is statistically significant(P<0. 05),logistic regression analysis shows that the higher of the serum Cystatin C and the A-PACHEⅡ ≥15,oliguria tied to mortality in patients with acute kidney injury(P<0. 05). The above indicated the Cystatin C concentration plus APACHE EⅡ≥15 are the main factors related to prognosis of patients with acute kidney injury. Conclusion Serum Cystatin C and APACHE II scores are correlated,In addition of comprehensive therapy on Patients of ICU AKI,under the precondition of cystatin C rise combined with APACHE Ⅱ score ≥ 15 points can be used as evaluation index of the prognosis of patients with AKI.%目的 探讨ICU急性肾损伤(AKI)患者血清中胱抑素C(cystatin C)与急性病理生理学和慢性健康评价(APACHE)Ⅱ评分的关联性,初步评价两者在ICUAKI患者中的预后价值.方法 选取2010年6月至2011年5月该院ICU收治的32例AKI患者(AKI组)的血液标本,均符合AKI诊断标准.记录其cystatin C的变化,同时收集临床资料,包括性别,年龄,慢性疾病史,24 h内各种化验指标(血常规、血气分析、肾功能、血电解质等)的最差值,并对其进行APACHE Ⅱ评分.AKI组分为存活组和死亡组,另外选取同期入住ICU未发生AKI患者20例作为非AKI 组.结果 32例AKI组患者,死亡11例,死亡率34.4%.cystatin C水平随APACHE Ⅱ评分增多而升高,存活组与死亡组之间比较差异有统计学意义(P<0.05),Logistic回归分析显示cystatin C升高结合APACHEⅡ≥15分,少尿与AKI患者死亡率密切相关(P<0.05).结论 对ICU AKI患者进行综合治疗的前提下,cystatin C升高结合APACHEⅡ评分≥15分可以作为评价AKI患者预后的指标.