肝硬化患者肾小球滤过率、血清胱抑素C水平及肾阻力指数值的分析

Analysis of glomerular filtration rate, serum cystatin C levels, and renal resistive index values in cirrhosis patients.

作者信息

Ustundag Yucel, Samsar Ufuk, Acikgoz Sereften, Cabuk Mehmet, Kiran Sibel, Kulah Eyup, Aydemir Selim

机构信息

Department of Internal Medicine, Clinic of Gastroenterology, School of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey.

出版信息

Clin Chem Lab Med. 2007;45(7):890-4. doi: 10.1515/CCLM.2007.130.

DOI:10.1515/CCLM.2007.130

PMID:17617033

Abstract

BACKGROUND

The aim of this study was to evaluate the relation of glomerular filtration rate (GFR) to serum cystatin C levels, renal resistive index (RRI), serum creatinine and creatinine clearance in patients with different stages of cirrhosis.

METHODS

The study sample was 25 cirrhotic patients (10 females and 15 males; mean age 57.3+/-2.04 years), 10 in the compensated stage without ascites and 15 in the decompensated stage with new-onset ascites. None had azotemia nor were on diuretic treatment. The control group comprised 25 healthy adults (11 female and 14 men; mean age 56.56+/-1.91 years). Serum cystatin C, RRI, serum creatinine and creatinine clearance were measured. GFR was determined by technetium(99m)-diethylene triamine pentaacetic acid renal scintigraphy.

RESULTS

Cirrhosis cases had lower mean scintigraphic GFR than controls (64.5+/-4.03 vs. 87.96+/-4.16 mL/min, p<0.05). Serum cystatin C and RRI were significantly higher in the cirrhotic group compared to controls (1.16+/-0.09 mg/L and 0.68+/-0.01 vs. 0.86+/-0.03 mg/L and 0.64+/-0.01, respectively; p<0.05). Subgroup comparative analysis showed that only two parameters, scintigraphic GFR and serum cystatin C, were significantly different between compensated and decompensated cirrhotics (75.62+/-4.9 mL/min and 0.89+/-0.07 mg/L vs. 57.23+/-5.14 mL/min and 1.34+/-0.13 mg/L, respectively; p<0.05). Scintigraphic GFR showed significant correlation with cystatin C, but not with serum creatinine or creatinine clearance (r=-0.877, p<0.05) in decompensated patients. No correlation was observed between scintigraphic GFR and RRI or between serum cystatin C and RRI in all subjects. A receiver operator characteristics curve showed that cystatin C at a cutoff value of 1.01 mg/L can significantly differentiate patients with GFR <70 mL/min with 80% sensitivity and 80% specificity.

CONCLUSIONS

Serum cystatin C, but not serum creatinine or RRI measurement, correlates with GFR in each stage of liver failure and has a significant diagnostic advantage in detecting lower GFR in such cases.

摘要

背景

本研究旨在评估不同阶段肝硬化患者的肾小球滤过率（GFR）与血清胱抑素C水平、肾阻力指数（RRI）、血清肌酐及肌酐清除率之间的关系。

方法

研究样本为25例肝硬化患者（10例女性，15例男性；平均年龄57.3±2.04岁），其中10例处于无腹水的代偿期，15例处于新发腹水的失代偿期。所有患者均无氮质血症且未接受利尿剂治疗。对照组为25名健康成年人（11例女性，14例男性；平均年龄56.56±1.91岁）。检测血清胱抑素C、RRI、血清肌酐及肌酐清除率。通过锝（99m）-二乙三胺五乙酸肾闪烁显像测定GFR。

结果

肝硬化患者的平均闪烁显像GFR低于对照组（64.5±4.03 vs. 87.96±4.16 mL/min，p<0.05）。肝硬化组的血清胱抑素C和RRI显著高于对照组（分别为1.16±0.09 mg/L和0.68±0.01，对比0.86±0.03 mg/L和0.64±0.01；p<0.05）。亚组对比分析显示，仅闪烁显像GFR和血清胱抑素C这两个参数在代偿期和失代偿期肝硬化患者之间存在显著差异（分别为75.62±4.9 mL/min和0.89±0.07 mg/L对比57.23±5.14 mL/min和1.34±0.13 mg/L；p<0.05）。在失代偿期患者中，闪烁显像GFR与胱抑素C显著相关，与血清肌酐或肌酐清除率无关（r=-0.877，p<0.05）。在所有受试者中，未观察到闪烁显像GFR与RRI之间或血清胱抑素C与RRI之间存在相关性。受试者工作特征曲线显示，胱抑素C临界值为1.01 mg/L时，可显著区分GFR<70 mL/min的患者，灵敏度为80%，特异度为80%。