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目的探讨半胱氨酸蛋白酶抑制剂C(CystatinC)在预测和诊断心脏术后急性肾损伤(AKI)中的价值。方法前瞻性收集我院132例接受心肺旁路手术的病人,每位病人术前及术后每天采集血标本。同时应用酶法测血清肌酐(Scr),用颗粒增强透射免疫比浊法(PETIA)检测血清CystatinC,用MDRD公式估算肾小球滤过率(eGFR)。AKI运用ADQI的RIFLE标准进行诊断(R:Scr升高≥50%基础值,I:Scr升高≥100%基础值,F:Scr升高≥200%基础值,L:肾功能丧失;E:终末期肾脏病);同时AKI也按CystatinC≥50%、≥100%和≥200%的标准进行诊断。结果29(21.9%)例病人发生不同程度AKI,其中10例经历R标准,12例经历I标准,7例经历F标准。其余103例没有发生AKI的病人作为对照组。AKI病人的CystatinC较非AKI病人显著升高(P<0.001),AKI病人的CystatinC与Scr(r=0.732,P<0.001)、[CystatinC]-1与eGFR(r=0.803,P<0.001)成明显线性相关。分别按照CystatinC和Scr两种方法诊断AKI,不同程度AKI诊断的中位时间是:R标准的10例病人分别为2d(1~4d)和3d(2~5d)(P=0.014),I标准12例病人分别为3.5d(1~6d)和5d(2~8d)(P=0.008),F标准7例病人分别为5d(3~7d)和6.5d(4~9d)(P=0.02)。ROC分析证实CystatinC在AKI诊断中的准确性高(曲线下面积为0.992)。当以CystatinC升高≥50%作为AKI的诊断截点时,CystatinC在AKI诊断中的敏感性和特异性分别为92%和95%。结论CystatinC可作为心肺旁路手术后AKI的诊断指标;CystatinC在AKI的诊断时间上较Scr早,它可能作为AKI的早期预测指标之一。
Objective To investigate the value of cystatin C in predicting and diagnosing acute renal injury (AKI) after cardiac surgery. Methods We prospectively collected 132 patients who underwent cardiopulmonary bypass surgery in our hospital. Blood samples were collected daily before and after each patient. At the same time, Serum creatinine (Scr) was detected by enzymatic method. Serum Cystatin C was detected by particle enhanced transillumination immunoturbidimetry (PETIA), and glomerular filtration rate (eGFR) was estimated by MDRD formula. AKI was diagnosed using the RIFLE criteria for ADQI (R: Scr ≥50% basal, I: Scr ≥100% basal, F: Scr ≥200% basal, L: loss of renal function; E: End-stage renal disease); AKI also CystatinC ≥ 50%, ≥ 100% and ≥ 200% of the standard diagnosis. Results 29 (21.9%) patients had different degrees of AKI. Among them, 10 patients underwent R criteria, 12 patients underwent I criteria and 7 patients underwent F criteria. The remaining 103 patients who did not develop AKI served as controls. Cystatin C in AKI patients was significantly higher than that in non-AKI patients (P <0.001). Cystatin C and Scr (r = 0.732, P <0.001), [Cystatin C] -1 and eGFR (r = 0.803, Significant linear correlation. AKI was diagnosed by Cystatin C and Scr respectively. The median time to diagnosis of AKI was 2 days (1-4 days) and 3d (2-5 days) respectively (P = 0.014) The patients in the 12 cases were 3.5 days (1-6 days) and 5 days (2-8 days) respectively (P = 0.008). The 7 patients in the F standard were 5 days (3-7 days) and 6.5 days (4-9 days) ). ROC analysis confirmed the high accuracy of Cystatin C in AKI (area under the curve 0.992). The sensitivity and specificity of Cystatin C in the diagnosis of AKI were 92% and 95%, respectively, when the ≥ 50% increase in Cystatin C was used as the cut-off point for AKI. Conclusion Cystatin C can be used as a diagnostic index for AKI after cardiopulmonary bypass. Cystatin C is earlier than Scr in diagnosis of AKI, which may be one of the early predictors of AKI.