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胱抑素C对病毒性肝炎患者早期肾损伤的诊断价值
Value of cystatin C in the diagnosis of early renal injury in patients with viral hepatitis
文章发布日期:2019年09月29日  来源:  作者:朱娅鸽, 王静, 刘锦锋, 等  点击次数:177次  下载次数:41次

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【摘要】: 目的 探讨血清胱抑素C(Cys C)检测在病毒性肝炎早期肾损伤诊断中的意义。方法 回顾性分析2018年1月1日-2018年12月31日西安交通大学第一附属医院270例慢性HBV感染及HCV感染者临床资料,按FibroScan检测的肝纤维化程度分为4组:无明显肝纤维化组(F0~F2)、明显肝纤维化组(F2~F3)、进展性肝纤维化组(F3~F4)、肝硬化组(>F4),比较各组尿素氮、肌酐、Cys C及估算的肾小球滤过率(eGFR)水平差异。计量资料2组间比较采用t检验;多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验。相关性检验使用Pearson相关分析。结果 270例患者中,HBV感染者200例,HCV感染者70例。eGFR及Cys C水平在4组中差异均有统计学意义(F值分别为2.714、3.081,P值分别为0.032、0.017)。进一步两两比较,肝硬化组的eGFR低于无明显纤维化组[(99.61±6.92)ml·min-1·1.73 m-2 vs (105.32±1.86)ml·min-1·1.73 m-2,t=2.655,P=0.008];与无明显肝纤维化组相比,明显肝纤维化组[(1.01±0.08) mg/L vs (0.84±0.03) mg/L,t=-2.218,P=0.028]、进展性纤维化组[(1.02±0.04)mg/L vs (0.84±0.03) mg/L,t=-4.218,P<0.001]及肝硬化组[(1.07±0.05) mg/L vs (0.84±0.03) mg/L,t=-4.675,P<0.001]的Cys C水平均明显升高。HBV感染者和HCV感染者肝硬化组的Cys C水平明显高于无明显纤维化组[HBV感染者:(1.06±0.36)mg/L vs(0.84±0.13)mg/L,t=-3.192,P=0.003;HCV感染者:(1.04±0.22)mg/L vs(0.86±0.15)mg/L,t=-2.318,P=0.029]。肝脏硬度值与Cys C水平呈正相关(r=0.247,P=0.003),与eGFR水平无相关(r=-0.002,P=0.975)。结论 Cys C能更早期发现病毒性肝炎患者的肾功能损伤,常规监测Cys C水平对防治该类患者发展为肝肾综合征具有积极意义。
【Abstract】: Objective To investigate the value of serum cystatin C (Cys C) in the diagnosis of early renal injury in patients with viral hepatitis. Methods A retrospective analysis was performed for the clinical data of 270 patients with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. According to the fibrosis degree determined by FibroScan, the patients were divided into non-significant liver fibrosis group (F0-F2), significant liver fibrosis group (F2-F3), progressive liver fibrosis group (F3-F4), and liver cirrhosis group (>F4). The four groups were compared in terms of urea nitrogen, creatinine, Cys C, and estimated glomerular filtration rate (eGFR). The t-test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between two groups. A Pearson correlation analysis was used to investigate correlation. Results Among the 270 patients, 200 had HBV infection and 70 had chronic HCV infection. There were significant differences in eGFR and Cys C between the four groups (F=2.714 and 3.081, P=0.032 and 0.017). Further comparison between two groups showed that the liver cirrhosis group had a significantly lower eGFR than the non-significant liver fibrosis group (99.61±6.92 ml·min-1·1.73 m-2 vs 105.32±1.86 ml·min-1·1.73 m-2, t=2.655, P=0.008); compared with the non-significant liver fibrosis group, the other three groups had significant increases in the serum level of Cys C (significant liver fibrosis group: 1.01±0.08 mg/L vs 0.84±0.03 mg/L, t=-2.218, P=0.028; progressive liver fibrosis group: 1.02±0.04 mg/L vs 0.84±0.03 mg/L, t=-4.218, P<0.001; liver cirrhosis group: 1.07±0.05 mg/L vs 0.84±0.03 mg/L, t=-4.675, P<0.001). For the patients with HBV or HCV infection, the patients with liver cirrhosis had a significantly higher serum level of Cys C than those without significant liver fibrosis (patients with HBV infection: 1.06±0.36 mg/L vs 0.84±0.13 mg/L, t=-3.192, P=0.003; patients with HCV infection: 1.04±0.22 mg/L vs 0.86±0.15 mg/L, t=-2.318, P=0.029). Liver stiffness measurement was positively correlated with the serum level of Cys C (r=0.247, P=0.003), while there was no correlation between liver stiffness measurement and eGFR (r=-0.002, P=0.975). Conclusion Cys C can be used for the diagnosis of early renal injury in patients with viral hepatitis, and regular monitoring of Cys C level has a positive significance in the prevention and treatment of hepatorenal syndrome in such patients.
【关键字】:乙型肝炎, 慢性; 丙型肝炎, 慢性; 肝硬化; 肾损伤
【Key words】:hepatitis B, chronic; hepatitis C, chronic; liver cirrhosis; kidney injury
【引证本文】:ZHU YG, WANG J, LIU JF, et al. Value of cystatin C in the diagnosis of early renal injury in patients with viral hepatitis[J]. J Clin Hepatol, 2019, 35(11): 2453-2455. (in Chinese)
朱娅鸽, 王静, 刘锦锋, 等. 胱抑素C对病毒性肝炎患者早期肾损伤的诊断价值[J]. 临床肝胆病杂志, 2019, 35(11): 2453-2455.

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