胱抑素C、血浆尾加压素Ⅱ在失代偿期肝硬化合并肝肾综合征患者中的诊断价值

摘要

目的 探讨胱抑素C(CysC)、血浆尾加压素Ⅱ(uⅡ)在失代偿期肝硬化合并肝肾综合征(HRS)患者中的诊断价值.方法 收集2011年2月-2011年11月于常州市第一人民医院消化内科住院的失代偿期肝硬化患者50例,计算其校正内生肌酐清除率(Ccr),并根据Ccr分为单纯肝硬化组、亚临床HRS组及HRS组,以15例健康体检者为对照组,检测ALT、AST、总胆汁酸(TBA)、Alb、血清肌酐(Scr)、CysC、uⅡ浓度,比较各组上述指标的差异,若数据成正态分布且方差齐,进行单因素方差分析(One-Way ANOVA),两组间比较采用t检验；否则,多组间进行非参数秩和检验(Kruskall-Wallis H test),两组间比较使用Mann-Whjtney U检验.相关分析采用Spearman相关检验.并通过绘制CysC、uⅡ浓度判断肝硬化合并亚临床HRS及HRS的ROC曲线,获得其曲线下面积(AUC)及最佳临界值.结果 肝硬化病例组与正常对照组ALT、AST、TBA、Alb、Scr、Cysc、uⅡ比较差异有统计学意义.单纯肝硬化组、亚临床HRS组及HRS组CysC、uⅡ浓度均呈升高趋势,差异具有统计学意义(P＜0.05).CysC和uⅡ判断亚临床HRS的AUC分别为0.91和0.867,其最佳临界值分别为1.40 mg/L、299.06 pg/ml.CysC和uⅡ判断HRS的AUC分别为0.942和0.901,其最佳临界值分别为2.22 mg/L、321pg/ml.结论 CysC、uⅡ浓度在患者血清肌酐正常时就出现升高改变,有助于早期发现亚临床HRS.CysC、uⅡ浓度对失代偿期肝硬化患者并发亚临床HRS及HRS有很好的判别价值.%Objective To evaluate the relation of serum cystatin C (CysC) and urotensin Ⅱ (uⅡ) levels with presence of hepatorenal syndrome in patients with decompensated liver cirrhosis to determine the diagnostic potential for these serum markers in order to facilitate early detection of hepatorenal syndrome at subclinical stages.Methods A total of 50 patients with decompensated liver cirrhosis were recruited for study and divided into three groups according to creatinine elimination rate (Ccr):simple liver cirrhosis,≥80 ml/min (n =22) ; subclinical hepatorenal syndrome,40≤ Ccr ＜ 80 ml/min (n =19) ; and hepatorenal syndrome,≤40 ml/min (n =9).Fifteen healthy individuals were recruited for use as controls.Fasting blood samples were collected from all cases and controls for measurements of alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bile acid (TBA),albumin (Alb),serum creatinine (Scr),CysC,and uⅡ.For normally distributed data,single-factor analysis was carried out by One-Way ANOVA and pairwise comparisons were carried out by the Student's t-test; for non-normally distributed data,the Kruskall-Wallis H test and Mann-Whitney U test were used,respectively.Correlation analysis was carried out with the Spearman's rank correlation coefficient.Diagnostic accuracy was assessed by generating a receiver operating characteristic (ROC) curve and using the area under the curve (AUC) to select the optimal threshold for diagnosing subclinical hepatorenal syndrome and hepatorenal syndrome in patients with decompensated liver cirrhosis.Results Compared to the healthy controls,the cirrhosis cases had significantly higher levels of ALT,AST,TBA,ALB,Scr,CysC,and uⅡ (all P ＜ 0.05).However,among the cirrhotic patients,those with subclinical hepatorenal syndrome and hepatorenal syndrome had slightly,but significantly,higher levels of CysC and uⅡ than the patients with simple cirrhosis (both P ＜ 0.05).For subclinical hepatorenal syndrome,the AUCs of CysC and uⅡ were 0.91 and 0.867 and the optimal thresholds were 1.40 mg/L and 299.06 pg/ml respectively.For hepatorenal syndrome,the AUCs of CysC and uⅡ were 0.942 and 0.901 and the optimal thresholds were 2.22 mg/L and 321 pg/ml respectively.Conclusion Enhanced levels of serum CysC and uⅡ can reflect hepatorenal damage in patients with decompensated liver cirrhosis,even when serum creatinine levels are within normal range,suggesting that these two serum markers may have diagnostic value for detecting subclinical hepatorenal syndrome and hepatorenal syndrome at early stages in this patient population.