|
摘要：
|
|
摘要：目的 探讨胱抑素C（cystatin C，Cys-C）和β2微球蛋白（β2 microglobulin，β2-MG）在肝硬化
合并不同类型肾损伤中的诊断价值及意义。方法 回顾性分析2015年1月至2018年11月于延安大学附属
医院住院治疗的1861例肝硬化患者的临床资料，根据是否合并肾损伤分为单纯肝硬化组（857例）和
肝硬化合并肾损伤组（1004例）。根据肾损伤类型将肝硬化合并肾损伤组分为急性肾小管坏死（acute
tubular necrosis，ATN）组（23例）、肝肾综合征（hepatorenal syndrome，HRS）型急性肾损伤（acute
kidney injury，AKI）组（44例）、肾前性氮质血症（prerenal axotemia，PRA）组（24例）和亚临床
HRS组（913例）。比较不同组间Cys-C、血尿素氮（blood urea nitrogen，BUN）、β2-MG及血肌酐
（serum creatinine，SCr）等生物化学指标；比较各组上消化道出血、自发性腹膜炎、电解质紊乱及
肝性脑病等并发症发生情况。采用Spearman相关性分析Cys-C、β2-MG和BUN与SCr的相关性。采用受
试者工作特征（receiver operator characteristic，ROC）曲线比较Cys-C、β2-MG、SCr、BUN及Cys-C +
β2-MG对肝硬化合并不同类型肾损伤的诊断效能。结果 ①单纯肝硬化组和肝硬化合并肾损伤组患者性
别、病因、吸烟和饮酒间差异无统计学意义（P ＞ 0.05），Cys-C（中位数：0.99 mg/L vs 3.01 mg/L）、β2-MG
（中位数：2.30 mg/L vs 12.00 mg/L）、SCr（中位数：56.58 μmol/L vs 66.30 μmol/L）及BUN（中位
数：4.90 μmol/L vs 6.00 μmol/L）差异有统计学意义（P ＜ 0.05）。肝硬化合并肾损伤患者Child-Pugh
分级以B级为主（42.83%），单纯肝硬化组以A级为主（78.88%；χ 2 = 540.901，P = 0.001）；肝硬
化合并肾损伤组并发症发生率显著高于单纯肝硬化组（χ 2 = 66.019，P ＜ 0.001）。②ATN组、HRS-
AKI组、PRA和亚临床HRS组间Cys-C（中位数：4.79 mg/L vs 2.52 mg/L vs 1.97 mg/L vs 1.15 mg/L）、
β2-MG（中位数：11.74 mg/L vs 7.02 mg/L vs 4.42 mg/L vs 2.94 mg/L）、SCr（中位数：509.18 μmol/L vs
231.61 μmol/L vs 186.52 μmol/L vs 58.34 μmol/L）及BUN（中位数：18.80 μmol/L vs 13.85 μmol/L vs
9.45 μmol/L vs 5.30 μmol/L）水平差异有统计学意义（P ＜ 0.001）。③Spearman相关性分析表明
BUN、Cys-C均与SCr具有一定相关性（r s = 0.416、0.468，P ＜ 0.001），β2-MG与SCr无明显相关
性（r s = 0.131，P ＜ 0.001）。④Cys-C + β2-MG联合检测ATN、HRS-AKI、PRA及亚临床HRS的曲
线下面积分别为0.994、0.958、0.931、0.989，除ATN外，均优于其他指标单独检测（P ＜ 0.05）。
⑤Cys-C、β2-MG、SCr、BUN及Cys-C + β2-MG诊断肝硬化合并ATN（敏感性：100.0% vs 100.0% vs
100.0% vs 87.0% vs 100.0%；特异度：75.6% vs 85.1% vs 70.9% vs 74.4% vs 93.4%）、HRS-AKI（敏
感性：91.0% vs 87.7% vs 93.0% vs 76.4% vs 95.5%；特异度：79.7% vs 83.4% vs 69.8% vs 62.5% vs
95.0%）、PRA（敏感性：81.6% vs 73.4% vs 83.0% vs 71.0% vs 91.7%；特异度：77.0% vs 63.9% vs
61.3% vs 57.4% vs 82.4%）和亚临床HRS（敏感性：89.0% vs 78.0% vs 81.2% vs 72.4% vs 91.0%；特异
度：62.6% vs 81.3% vs 71.4% vs 63.7% vs 77.2%）的敏感性和特异度差异均有统计学意义（P ＜ 0.05）。
结论 Cys-C + β2-MG联合检测不仅可用于肝硬合并肾损伤的早期诊断，也有助于不同类型肾损伤的鉴
别诊断，诊断效能优于SCr，值得进一步研究。
|
|
Abstract: Objective To investigate the efficacy and clinical significance of cystatin C (Cys-C) and β2
microglobulin (β2-MG) on the diagnosis of liver cirrhosis complicated with different types of kidney injury.
Methods The clinical data of 1861 cases with liver cirrhosis in Affiliated Hospital of Yan’an University from
January 2015 to November 2018 were retrospectively analyzed. According to whether with kidney injury or
not, the patients were divided into simple liver cirrhosis group (857 cases) and liver cirrhosis complicated
with kidney injury group (1004 cases). According to the types of kidney injury, patients in liver cirrhosis
complicated with kidney injury group were furtherly divided into acute tubular necrosis (ATN) group (23
cases), hepatorenal syndrome acute kidney injury (HRS-AKI) group (44 cases), prerenal axotemia (PRA)
group (24 cases) and subclinical HRS group (913 cases). Cys-C, blood urea nitrogen (BUN), β2-MG, serum
creatinine (SCr) and the incidence of complications (upper gastrointestinal bleeding, spontaneous peritonitis,
electrolyte disturbances and hepatic encephalopathy) were compared. Spearman correlation analysis was used
to analyze the correlation of Cys-C, β2-MG, BUN and SCr. Receiver operator characteristic (ROC) curve was
used to compare the diagnostic efficacy of combined detection of Cys-C, β2-MG, SCr, BUN and Cys-C + β2-
MG on liver cirrhosis complicated with different types of kidney injury. Results ①There were no significant
differences in gender, etiology, smoking and drinking between patients in simple liver cirrhosis group and
liver cirrhosis complicated with kidney injury group (P ＞ 0.05), the differences of Cys-C (median: 0.99 mg/L
vs 3.01 mg/L), β2-MG (median: 2.30 mg/L vs 12.00 mg/L), SCr (median: 56.58 μmol/L vs 66.30 μmol/L) and
BUN (median: 4.90 μmol/L vs 6.00 μmol/L) were statistically significant (P ＜ 0.05). Grade B was the main
Child-Pugh grade of patients in liver cirrhosis complicated with kidney injury group (42.83%), and Grade A
was the main Child-Pugh grade of patients in simple liver cirrhosis group (78.88%; χ 2 = 540.901, P = 0.001).
The incidence of complications in liver cirrhosis complicated with kidney injury group was significantly
higher than that in simple liver cirrhosis group (χ 2 = 66.019, P ＜ 0.001). ②The differences of Cys-C (median:
4.79 mg/L vs 2.52 mg/L vs 1.97 mg/L vs 1.15 mg/L), β2-MG (median: 11.74 mg/L vs 7.02 mg/L vs 4.42 mg/L
vs 2.94 mg/L), SCr (median: 11.74 mg/L vs 7.02 mg/L vs 4.42 mg/L vs 2.94 mg/L) and BUN (median: 18.80
μmol/L vs 13.85 μmol/L vs 9.45 μmol/L vs 5.30 μmol/L) of patients in ATN group, HRS-AKI group, PRA and
subclinical HRS group were statistically significant (P ＜ 0.001). ③Spearman correlation analysis showed
that Cys-C and Urea had some correlation with SCr (r s = 0.416, 0.468; P ＜ 0.001), there was no significant
correlation between β2-MG and SCr (r s = 0.131, P ＜ 0.01). ④The area under curve of Cys-C + β2-MG on
the diagnosis of ATN, HRS-AKI, PRA and subclinical HRS were 0.994, 0.958, 0.931 and 0.989, respectively,
which were better than other indicators alone except for ATN (P ＜ 0.05). ⑤The differences in sensitivity and
specificity of Cys-C, β2-MG, SCr, BUN and Cys-C + β2-MG on the diagnosis of liver cirrhosis complicated
with ATN (sensitivity: 100.0% vs 100.0% vs 100.0% vs 87.0% vs 100.0%; specificity: 75.6% vs 85.1% vs
70.9% vs 74.4% vs 93.4%), HRS-AKI (sensitivity: 91.0% vs 87.7% vs 93.0% vs 76.4% vs 95.5%; specificity:
79.7% vs 83.4% vs 69.8% vs 62.5% vs 95.0%), PRA (sensitivity: 81.6% vs 73.4% vs 83.0% vs 71.0% vs
91.7%; specificity: 77.0% vs 63.9% vs 61.3% vs 57.4% vs 82.4%) and subclinical HRS (sensitivity:89.0% vs
78.0% vs 81.2% vs 72.4% vs 91.0%; specificity: 62.6% vs 81.3% vs 71.4% vs 63.7% vs 77.2%) were statistically
significant (P ＜ 0.05). Conclusions The combined detection of Cys-C and β2-MG can be used not only for the
early diagnosis of liver cirrhosis complicated with kidney injury, but also for the differential diagnosis of different
types of kidney injury, and the diagnostic efficacy is better than SCr, which deserves further study.
|
|
基金项目：
|
|
|
|
作者简介：
|
|
|
|
参考文献：
|
|
|
|
服务与反馈：
|
|
【文章下载】【加入收藏】
|
|
|
|