血清胱抑素C在早期诊断急性梗阻性化脓性胆管炎并发急性肾损害中的应用价值

摘要

目的 探讨血清胱抑素C(Cys C)在早期诊断急性梗阻性化脓性胆管炎(AOSC)并发急性肾损伤(AKI)中的应用价值.方法 回顾性分析2010年1月至2016年1月在我科接受诊治的62例AOSC 患者临床资料.所有患者均签署知情同意书,符合医学伦理学规定.测定62例患者的24h肌酐清除率(Ccr),血清肌酐(SCr),以及血清CysC水平,并以Ccr<80mL/(min·1.73 m 2)作为肾功能损害诊断标准,采用 检验,相关性分析和ROC曲线分析了解CysC的诊断应用价值.结果 62例患者中共有16例出现Ccr下降,在这16例患者中,CysC水平上升的有12例.而SCr出现异常的仅有5例,检验分析后提示CysC对Ccr的评估效能优于SCr,差异有统计学意义( =4.518,P<0.05).相关性分析提示AOSC患者中,CysC与SCr均和Ccr有着显著的负相关性(CysC:r= -0.642,P<0.001;SCr:r= -0.433,P<0.001),而CysC的相关系数较高.ROC曲线分析提示CysC的曲线下面积(AUC)值明显高于SCr(0.923 vs.0.785).结论 血清CysC可作为早期诊断AOSC并发AKI的检测指标,监测AOSC患者CysC水平,对预防AKI的发生及对指导治疗、改善预后及降低AOSC患者死亡率具有重大意义.%Objective To investigate the application value of serum cystatin C(CysC) in early diagnosis of acute obstructive suppurative cholangitis(AOSC) complicated with acute kidney injury(AKI).Methods The clinical data of 62 patients with AOSC diag-nosed and treated in Department of hepatobiliary surgery of Southwest Medical University from January 2010 to January 2016 were ana-lyzed retrospectively.All patients signed informed consent,and the study complied with the provisions of medical ethics.The Creatinine clearance rate(Ccr) for 24h,serum creatinine(SCr),and level of serum CysC in the 62 cases of patientswere measured.Ccr<80mL/(min·1.73 m2) was used as the diagnostic standard of renal impairment.And x2 test,correlation analysis and ROC curve analysis were used to understand the diagnostic value of CysC.Results Of the 62 patients,16 had Ccrdecreased,and in which 12 had elevated CysC levels.There were only 5 cases of SCr abnormalities. test showed that the evaluation efficiency of CysC on Ccr was better than that of SCr,and the difference was statistically significant( =4.518,P<0.05).Correlation analysis showed that there was a significant negative correlation between CysC and SCr and Ccr in patients with AOSC.(CysC:r= -0.642,P<0.001;SCr:r= -0.433,P<0.001),While the correlation coefficient of CysC was high.ROC curve analysis indicated that the area under the curve(AUC) of CysC was significantly higher than that of SCr(0.923 vs 0.785).Conclusion Serum CysC can be used as an early detection index of AOSC complicated with AKI,and monitoring the level of CysC in patients with AOSC is of great significance to prevent the occurrence of AKI,to guide the treat-ment,to improve prognosis and to reduce the mortality of patients with AOSC.