摘要目的 了解血清胱抑素C(CysC)在危重病儿童肾损害诊断中的临床价值.方法 对2007年1月至2008年12月在我院PICU住院的142例危重病患儿测得的CysC、血清肌酐(SCr)和内生肌酐清除率(Ccr)数据进行归纳整理,疾病危重程度依据小儿危重病例评分法评分.以CysC＞1.50 mg/L为阳性,根据传统金标准Ccr＜80ml/(min·1.73m~2)诊断为肾损害,对肾损害进行受试者工作特征(ROC)曲线分析,获得最佳诊断界点值,评价其敏感性和特异性.结果 根据Ccr标准和CysC标准得出的肾损害诊断率分别为40.8%(58/142)、50.7%(72/142),差异有非常显著性(χ~2=64.93,P＜0.001);ROC曲线分析显示肾损害最佳诊断界点为1.55 mg/L,敏感性94.8%,特异性81.0%.ROC曲线下面积为0.98(95%CI 0.97～0.98),用于诊断危重病儿童.肾损害有统计学意义(P=0.000).结论 CysC标准诊断危重病儿童肾损害有临床意义,与Ccr标准相比,能够提高肾损害诊断敏感性和特异性.

abstractsObjective To investigate the clinical significance of serum cystatin C(CysC)level in the diagnosis of renal damage in critically ill children.Methods One handred and forty-two critically ill children admitted to the Boai Hospital pediatric intensive care unit from January 2007 to December 2008 were included in the study.CysC,serum creafinine(SCr)and creatinine clearance rate(Ccr)were collected and analyzed.Pediatric critical illness scoring was done to assess the degree of disease.Renal damage was established according to Ccr＜80 ml/(min·1.73 m~2)(traditional gold standard)and CysC＞1.50 mg/L.The receiver operating characteristic(ROC)was analyzed to get the best point value of the diagnosis,and evaluated its sensitivity and specificity.Results According to the Ccr and CysC standards,the incidence of renal injury were 40.8%(58/142)and 50.7%(72/142),respectively(χ~2 =64.93,P＜0.001);ROC curve analysis showed that the best diagnosis point of renal injury was 1.55 mg/L;sensitivity of 94.8%,specificity 81.0%.Area under the ROC curve was 0.98(95%CI 0.97～0.98),for the diagnosis of renal damage in critically ill children was statistically significant(P=0.000).Conclusion Serum cystatin C level is a better marker of renal damage than the Ccr,can increase the diagnostic sensitivity and specificity.of renal damage in critically ill children.