摘要目的 旨在探讨血清胱抑素C (Cys C)诊断肝硬化患者急性肾损伤(AKI)的价值. 方法 采用颗粒增强免疫比浊法检测150例患者(其中肝硬化AKI患者88例,肝硬化非AKI患者62例)的血清Cys C水平.应用受试者工作特征曲线评估血清Cys C诊断肝硬化急性肾损伤的准确性. 结果 肝硬化AKI组患者血清Cys C水平显著高于非AKI组,分别为2.37 (1.75 ～ 2.83) mg/L和0.97 (0.85 ～ 1.09) mg/L,差异有统计学意义(Z=-10.236,P＜ 0.001).血清Cys C水平在急性肾小管坏死组患者最高,为5.41 (2.77 ～ 6.19) mg/L,肝肾综合征组为2.55 (2.28 ～ 3.59) mg/L和肾前性氮质血症组为2.07 (1.70～ 2.41) mg/L,三组比较差异有统计学意义(x2=23.217,P＜ 0.001).此外,将AKI患者分为感染组和非感染组,感染组血清Cys C水平显著高于非感染组,差异有统计学意义(Z=-2.509,P＜0.05).血清Cys C诊断肝硬化急性肾损伤的受试者工作特征曲线下面积为0.99 (0.98 ～ 1.00),Cut-off值为1.36 mg/L,其敏感度和特异度分别为97％和95％.结论 血清Cys C是检测肝硬化急性肾损伤的良好指标,其升高程度有助于区分不同的肾损伤类型.

abstractsObjective To determine the diagnostic value of serum cystatin C (Cys C) for acute kidney injury (AKI) in patients with liver cirrhosis.Methods Serum Cys C levels in 150 liver cirrhosis patients (88 AKI and 62 non-AKI patients) were measured by the Particle-Enhanced Nephelometric Immuno-Assay.The accuracy of serum Cys C for the diagnosis of AKI in liver cirrhosis was evaluated by the ROC curve.Results Liver cirrhosis patients with AKI had significantly higher serum Cys C levels [2.37 (1.75-2.83) mg/L] than those without AKI [0.97 (0.85-1.09) g/L] (P ＜0.001).Serum Cys C level was highest in the acute tubular necrosis group [5.41 (2.77-6.19) mg/L],followed by the hepatorenal syndrome group [2.55 (2.28-3.59)mg/L] and prerenal azotemia group [2.07 (1.70-2.41) mg/L],and the serum Cys C level was significantly different between the three groups (P ＜0.001).In addition,patients with AKI were further divided into infection group and non-infection group.Serum Cys C level was significantly higher in the infection group than in the non-infection group (P ＜0.05).The area under the ROC curve of serum Cys C for the diagnosis of AKI in liver cirrhosis was 0.99 (0.98-1.00) at a cut-offvalue of 1.36 mg/L,and the sensitivity and specificity were 97％ and 95％,respectively.Conclusion Serum Cys C is a good marker for detecting AKI in liver cirrhosis,and the different levels of increase in Cys C may be useful in differentiating the different types of AKI.