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血清胱抑素C联合尿中性粒细胞明胶酶相关脂质运载蛋白对肝硬化腹水继发急性肾损伤的诊断价值
Value of combined measurement of serum cystatin C and urinary neutrophil gelatinase-associated lipocalin in diagnosis of acute kidney injury secondary to cirrhotic ascites
文章发布日期:2017年12月09日  来源:  作者:雷蕾,李良平,张虎  点击次数:546次  下载次数:125次

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【摘要】:目的 探讨血清胱抑素C(Cys C)联合尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)检测在肝硬化腹水继发急性肾损伤(AKI)中的临床诊断价值。方法 收集2015年1月-2016年6月四川省人民医院收治的105例肝硬化腹水患者的临床资料,将患者分为AKI组(n=56)和非AKI组(n=49),同时选取健康体检者(n=40)作为对照。观察血清Cys C、尿NGAL、血肌酐(Scr)水平及肾小球滤过率(GFR)等指标。同时将纳入的105例肝硬化腹水患者按照肝功能Child-Pugh分级划分,比较不同Child-Pugh分级患者的血清Cys C、尿 NGAL、SCr、GFR变化。计量资料2组间比较采用独立样本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SNK-q检验。计数资料组间比较采用χ2检验。相关性分析采用Pearson相关分析法。结果 AKI组患者血清Cys C水平、尿 NGAL浓度与非AKI组和健康对照组相比,差异均有统计学意义(P值均<0.01)。将AKI患者依照肾损伤标准进行分期,分期高者血清Cys C水平、尿 NGAL浓度显著高于分期低的患者(P值均<0.05)。56例AKI患者中,11例死亡,病死率为19.6%;死亡患者血清CysC水平、尿NGAL浓度均高于存活患者,差异有统计学意义(t值分别为-7.742、-3.209,P值均<0.01)。相关分析显示,AKI患者血清Cys C水平、尿 NGAL浓度与GFR呈负相关(r值分别为-0.915、-0.793,P值均<0.01)。随着Child-Pugh分级的上升,肝硬化腹水患者血清Cys C水平、尿 NGAL浓度上升,GFR逐渐下降,差异均有统计学意义(P值均<0.05)。结论 血清CysC联合尿NGAL检测可作为肝硬化腹水继发AKI的早期诊断指标,并且可作为评价肝硬化腹水继发AKI严重程度及预后的指标。
【Abstract】:Objective To investigate the value of combined measurement of serum cystatin C (Cys C) and urinary neutrophil gelatinase-associated lipocalin (NGAL) in the diagnosis of AKI secondary to cirrhotic ascites. Methods A total of 105 patients with cirrhotic ascites who were admitted to Sichuan Provincial People′s Hospital from January 2015 to June 2016 were enrolled and divided into AKI group with 56 patients and non-AKI group with 49 patients. Meanwhile, 40 healthy persons who underwent physical examination were enrolled as controls. The indices including serum Cys C, urinary NGAL, serum creatinine (Scr), and glomerular filtration rate (GFR) were observed. The 105 patients with cirrhotic ascites were divided into subgroups according to Child-Pugh class, and the changes in serum Cys C, urinary NGAL, Scr, and GFR were compared between these subgroups. The independent samples 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 SNK-q test was used for further comparison between any two groups. The chi-square test was used for comparison of categorical data between groups, and a Pearson correlation analysis was also performed. Results There were significant differences in the levels of serum Cys C and urinary NGAL between the AKI group and the non-AKI group, as well as between the AKI group and the healthy control group (all P<0.01). AKI stage was determined for all AKI patients, and the AKI patients with a higher stage had significantly higher levels of serum Cys C and urinary NGAL than those with a lower stage (all P<0.05). Of all 56 AKI patients, 11 (19.6%) died; the patients who died had significantly higher levels of serum Cys C and urinary NGAL than those who survived (t=-7.742 and -3.209, both P<0.01). The correlation analysis showed that the levels of serum Cys C and urinary NGAL were negatively correlated with GFR (r=-0.915 and -0.793, both P<0.01). The levels of serum Cys C and urinary NGAL increased significantly and GFR decreased significantly with the increase in Child-Pugh class (all P<0.05). Conclusion Combined measurement of serum Cys C and urinary NGAL can be used for the early diagnosis of AKI secondary to cirrhotic ascites and the evaluation of the severity and prognosis of AKI.
【关键字】:肝硬化;腹水;急性肾损伤;胱抑素C;脂笼蛋白质类;诊断
【Key words】:liver cirrhosis; ascites; acute kidney injury; cystatin C; lipocalins; diagnosis
【引证本文】:LEI L, LI LP, ZHANG H. Value of combined measurement of serum cystatin C and urinary neutrophil gelatinase-associated lipocalin in diagnosis of acute kidney injury secondary to cirrhotic ascites[J]. J Clin Hepatol, 2018, 34(1): 101-105. (in Chinese)
雷蕾, 李良平, 张虎. 血清胱抑素C联合尿中性粒细胞明胶酶相关脂质运载蛋白对肝硬化腹水继发急性肾损伤的诊断价值[J]. 临床肝胆病杂志, 2018, 34(1): 101-105.

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