在脓毒症新生儿中，血清胱抑素C作为肾功能指标是否优于血清肌酐？

Is serum cystatin C a better marker of kidney function than serum creatinine in septic newborns?

作者信息

Maruniak-Chudek Iwona, Owsianka-Podleśny Teresa, Wróblewska Jolanta, Jadamus-Niebrój Danuta

机构信息

Department of Neonatal Intensive Care, Medical University of Silesia, Upper Silesian Centre of Child's Health, Katowice, Poland.

出版信息

Postepy Hig Med Dosw (Online). 2012 Apr 2;66:175-80. doi: 10.5604/17322693.988679.

DOI:10.5604/17322693.988679

PMID:22470193

Abstract

INTRODUCTION

Several studies have claimed that the estimation of serum cystatin C could be a better marker of kidney excretory function than serum creatinine. However, its role in the diagnosis of reduced kidney function was not unquestionably confirmed. The aim of this study was to analyze the concentrations of serum cystatin C in neonates with sepsis.

MATERIAL/METHODS: Thirty-two neonates (gestational age from 34 to 40 weeks) admitted to the NICU during the first 14 days of life were enrolled. Serum cystatin C concentrations were estimated by ELISA during three successive days in neonates treated for infection. The study group consisted of 9 newborns with sepsis, 14 with severe sepsis and 9 with septic shock.

RESULTS/DISCUSSION: At the beginning of the observational period the mean serum concentration of cystatin C in the study group was 1.35 mg/L (95% CI 1.20-1.49). Surprisingly, the lowest concentration of cystatin was observed in patients with septic shock (1.23 mg/L; 95%CI 0.92-1.54) within the observation period. Higher concentrations were found in neonates with sepsis (1.47 mg/L; 95%CI 1.04-1.90) and severe sepsis (1.50; 1.12-1.87). There was no correlation between serum cystatin C concentration and serum creatinine or gestational age. A significant correlation was discovered between chronological age and cystatin C (R=-0.439, p=0.01). There was a tendency for cystatin C to decline during the second observational day in patients with sepsis (to 1.53 mg/L; 95%CI: 1.19-1.86) and severe sepsis (to 1.32 mg/L; 95%CI: 1.07-1.57), while a slight insignificant increase in patient with septic shock (to 1.28 mg/L; 95%CI: 0.88-1.68) was revealed. The interrelation between age and cystatin C concentration disappeared in the following days of stay in the NICU. Even in patients who died in the course of septic shock the observed changes in cystatin C levels were small and did not exceed those of serum creatinine.

CONCLUSIONS

Cystatin C is not a useful marker of kidney function in neonates with sepsis.

摘要

引言

多项研究表明，血清胱抑素C的测定可能是比血清肌酐更好的肾脏排泄功能标志物。然而，其在肾功能减退诊断中的作用尚未得到明确证实。本研究的目的是分析脓毒症新生儿的血清胱抑素C浓度。

材料/方法：纳入出生后14天内入住新生儿重症监护病房（NICU）的32例新生儿（胎龄34至40周）。对接受感染治疗的新生儿连续三天采用酶联免疫吸附测定法（ELISA）测定血清胱抑素C浓度。研究组包括9例脓毒症新生儿、14例严重脓毒症新生儿和9例脓毒性休克新生儿。

结果/讨论：在观察期开始时，研究组血清胱抑素C的平均浓度为1.35mg/L（95%可信区间1.20 - 1.49）。令人惊讶的是，在观察期内，脓毒性休克患者的胱抑素C浓度最低（1.23mg/L；95%可信区间0.92 - 1.54）。脓毒症新生儿（1.47mg/L；95%可信区间1.04 - 1.90）和严重脓毒症新生儿（1.50；1.12 - 1.87）的浓度更高。血清胱抑素C浓度与血清肌酐或胎龄之间无相关性。发现实际年龄与胱抑素C之间存在显著相关性（R = -0.439，p = 0.01）。脓毒症患者（降至1.53mg/L；95%可信区间：1.19 - 1.86）和严重脓毒症患者（降至1.32mg/L；95%可信区间：1.07 - 1.57）在观察的第二天胱抑素C有下降趋势，而脓毒性休克患者有轻微的不显著升高（升至1.28mg/L；95%可信区间：0.88 - 1.68）。在入住NICU的后续几天，年龄与胱抑素C浓度之间的相互关系消失。即使在脓毒性休克过程中死亡的患者，观察到的胱抑素C水平变化也很小，且未超过血清肌酐的变化。