摘要
目的探讨血清胱抑素C(sCysC)对危重脑出血患者发生急性肾损伤(AKI)及预后的预测价值。方法回顾性分析2016年10月至2018年9月南方医科大学附属小榄医院重症医学科(ICU)收治的129例危重脑出血患者的临床资料,根据是否发生AKI分为AKI组和非AKI组,根据KDIGO分期将AKI组患者分为轻症AKI(KDIGO分期1期)和重症AKI(KDIGO分期2及3期)。比较不同组间sCysC及血肌酐水平的差异,利用ROC曲线评价sCysC对AKI早期诊断和临床预后的预测价值。结果129例危重脑出血患者中,67例(51.9%)发生AKI,其中41例为轻症AKI,26例为重症AKI。重症AKI组患者的sCysC水平为1.40 mg/L,明显高于非AKI组(0.72 mg/L)和轻症AKI组(0.95 mg/L),差异均有统计学意义(P<0.05);sCysC预测AKI和重症AKI的曲线下面积(AUC)分别为0.871和0.835;本研究队列整体住院死亡率为14.0%,ICU期间肾脏替代治疗(RRT)需求率为5.4%,AKI组住ICU期间RRT需求率为10.4%,明显均高于非AKI组的0,差异有统计学意义(P<0.05),AKI组患者住院死亡率为16.4%,略高于非AKI组的11.3%,但差异无统计学意义(P>0.05);sCysC预测危重脑出血患者住ICU期间RRT需求和住院死亡的AUC为0.755和0.646;随访发现31例患者发生慢性肾脏病(CKD),AKI患者继发CKD的风险为44.8%,明显高于非AKI患者的1.6%,差异有统计学意义(P<0.05),而sCysC预测CKD的AUC为0.888。结论sCysC可作为预测危重脑出血患者急性肾损伤的早期指标,并提供预测临床预后的相关信息。
Objective To explore the clinical value of serum cystatin C(sCysC)in predicting acute kidney injury(AKI)in severe cerebral hemorrhage patients.Methods In this study,we retrospectively analyzed the data of 129 severe cerebral hemorrhage patients who had been admitted to the adult mixed ICU of Xiaolan Hospital of Southern Medical University during October 2016 to September 2018.According to whether AKI occurs or not,the patients were divided into the AKI group and non-AKI group.AKI patients were divided into mild-AKI(Stage 1)and severe AKI(Stage 2,3)according to KDIGO Staging.Receiver operating characteristic(ROC)curve and the area under curve(AUC)were used to evaluate the biomarker'capability of detecting AKI and its prognosis.Results Among of 129 patients,67 patients developed AKI(35.5%),including 41 cases of mild-AKI and 26 cases of severe AKI.The sCysC level of severe AKI group was 1.40 mg/L,which was significantly higher than 0.72 mg/L of non-AKI group and 0.95 mg/L of mild-AKI group(P<0.05).sCysC was able to distinguish AKI and severe AKI from non-AKI with ROC of 0.871 and 0.835 respectively.In this cohort,the corhot’s in-hospital mortality was 14.0%,renal replacement therapy(RRT)rate during ICU was 5.4%;RRT rate during ICU in the AKI group was 10.4%,which was significantly higher than 0 in the non-AKI group(P<0.05).The in-hospital mortality in the AKI group was 16.4%,which was significantly higher than 11.3%in the non-AKI group(P>0.05).The AUC value of RRT during ICU and in-hospital mortality predicted by sCysC were 0.755 and 0.646 respectively.The following-up revealed that chronic kidney disease(CKD)was found in 31 patients.The incidence of CKD in the AKI group was 44.8%,which was significantly higher than 1.6%in the non-AKI group(P<0.05).Meanwhile,the AUC value of CKD predicted by sCysC was 0.888.Conclusion sCysC can be used as an early indicator for predicting diagnosis of AKI in severe cerebral hemorrhage and provide useful information about clinical prognosis.
作者
池锐彬
邹启明
李超锋
叶铨秋
梁美华
李炬带
CHI Rui-bin;ZOU Qi-ming;LI Chao-feng;YE Quan-qiu;LIANG Mei-hua;LI Ju-dai(Department of Critical Care Medicine,Xiaolan Hospital of Southern Medical University,Zhongshan 528415,Guangdong,CHINA)
出处
《海南医学》
CAS
2020年第1期10-13,共4页
Hainan Medical Journal
基金
广东省医学科研基金(编号：A2017557)
广东省中山市科技计划项目(编号：2016B1083)
关键词
血清胱抑素C
脑出血
急性肾损伤
诊断
预后
Cystatin C(CysC)
Severe cerebral hemorrhage
Acute kidney injury(AKI)
Diagnosis
Prognosis
