Cys-C、UREA、Scr检测在急性肾小球肾炎早期肾损伤评估中的意义

摘要

Objective To discuss the significance of Cys-C,UREA and Scr tests in early renal damage assessment of AGN patients.Methods 76 cases of AGN patients in our hospital from Mar 2014 to Mar 2015 were selected as the research objects.According to the AKI staging standard developed by AKIN in 2005,it was divided into 28 cases of AKI 1 patients (observation group A),26 cases of AKI 2 patients (observation group B),22 cases of AKI 3 patients (observation group C).At the same time,30 cases of healthy volunteers were selected as control group.The Cys-C,UREA and Scr values of each group were then detected and compared.Results Compared with Cys-C,UREA and Scr combination tests,the sensitivity of single-phase test for AGN renal injury was decreased,the specificity was decreased,the positive predictive value was decreased,the negative predictive value was improved,the accuracy was reduced,the missed diagnosis rate was reduced.Compared with sequential tests of Cys-C,UREA and Scr,the sensitivity of CysC,UREA and Scr single-phase test were decreased,the specificity was improved,the positive predictive value was increased,the negative predictive value was decreased,the accuracy was improved and the misdiagnosis rate was decreased (P ＜ 0.05).The difference was statistically significant (P ＜ 0.05).Conclusion Single test of Cys-C,UREA,Scr and triplicate,parallel tests of these three for AGN have different advantages.The parallel of indexes can improve the sensitivity and reduce the misdiagnosis rate.The sequentical of three indexes can improve the specificity and reduce the misdiagnosis rate.The choose of the appropriate joint test method to diagnose the condition of AGN renal injury should be based on real clinical situation.%目的 探讨胱抑素C(cystatin C,Cys-C)、尿素(UREA)、血肌酐(serum creatinine,Scr)检测在急性肾小球肾炎(acuteglomerulonephritis,AGN)早期肾损伤评估中的意义.方法 选取2014年3月至2015年3月于本院入院治疗的急性感染导致肾小球肾炎患者76例作为研究对象,根据2005年急性肾损伤网络(Acute kidney injury network,AKIN)制定的AKI分期标准将其分为AKI 1期患者28例(观察组A),AKI 2期患者26例(观察组B),AKI 3期患者22例(观察组C),另选取30例本院同期体检健康者作为对照组.测定各组间研究对象Cys-C、UREA及Scr值并进行比较.结果 三项并联试验AGN肾损伤较Cys-C、UREA、Scr单项检测灵敏度提高,特异性降低,阳性预测值降低,阴性预测值提高,准确度降低,降低漏诊率,三项串联联试验AGN肾损伤较Cys-C、UREA、Scr单项检测灵敏度降低,特异度提高,阳性预测值升高,阴性预测值降低,准确度提高,降低误诊率;各组Cys-C、UREA以及Scr指标均随着患者病情的加重而显著升高,差异均具有统计学意义(P＜0.05);结论 Cys-C、UREA、Scr及三项串联、并联试验诊断AGN各有优势,三项指标并联提高灵敏度,降低漏诊率,而三项指标串联提高特异性,降低误诊率,临床上应该根据实际需要选择合适的联合检测方法诊断AGN肾损伤情况.