尿胱抑素 C 水平对预测新生儿肾损伤的价值。

The Value of Urinary Cystatin C Level to Predict Neonatal Kidney Injury.

机构信息

Ali Asghar Hospital, Iran University of Medical Sciences, Tehran, Iran.

Iran University of Medical Sciences, Pediatric Renal Transplantation and Dialysis Research Center Tehran, Tehran, Iran.

出版信息

Curr Pharm Des. 2018;24(25):3002-3004. doi: 10.2174/1381612824666180918100819.

DOI:10.2174/1381612824666180918100819

PMID:30227813

Abstract

BACKGROUND

The role of urinary cystatin C to early predict acute kidney injury (AKI) in children and neonates remains uncertain. The present study aimed to assess and compare the level of urinary cystatin C in neonates with and those without AKI.

METHODS

This cross-sectional study was performed on 55 available neonates who were involved by AKI and admitted to the neonatal department at Ali-Asghar hospital in Tehran in 2016. 97 neonates with jaundice and normal serum creatinine level were randomly selected as the control group. In both groups and on admission, the urine levels of cystatin C and creatinine were measured.

RESULTS

The average urinary level of cystatin C was 162.87 ± 56.50 mmol/mole creatinine in the group with AKI and 68.06 ± 57.16 mmol/mole creatinine in the control group that was significantly higher in former group (p < 0.001). The measurement of cystatin C level in urine could predict kidney injury with a sensitivity of 98.2%, a specificity of 39.2%, a positive predictive value of 47.8%, a negative predictive value of 97.4%, and an accuracy of 60.5%. Assessment of the area under the receiver operating characteristic (ROC) analysis showed that measuring urinary cystatin C level could effectively discriminate kidney injury from normal kidney condition in neonates (AUC = 0.868, 95CI: 0.811 - 0.925, P < 0.001). The best cutoff value of urinary cystatin C level to predict kidney injury was shown to be 41.5 mmol/mole creatinine yielding a sensitivity of 98.2% and a specificity of 46.4%.

CONCLUSION

Measurement of cystatin C in urine is an early sensitive method to diagnose neonatal kidney injury.

摘要

背景

尿胱抑素 C 预测儿童和新生儿急性肾损伤 (AKI) 的作用尚不确定。本研究旨在评估和比较尿胱抑素 C 在患有 AKI 的新生儿和无 AKI 的新生儿中的水平。

方法

这是一项横断面研究，共纳入 2016 年在德黑兰阿里阿萨加尔医院新生儿科住院的 55 例 AKI 新生儿。随机选择 97 例有黄疸且血清肌酐水平正常的新生儿作为对照组。在两组中，均在入院时测量尿胱抑素 C 和肌酐水平。

结果

AKI 组尿胱抑素 C 平均水平为 162.87±56.50mmol/mol 肌酐，对照组为 68.06±57.16mmol/mol 肌酐，前者显著高于后者（p＜0.001）。尿胱抑素 C 水平的测量可以预测肾脏损伤，其灵敏度为 98.2%，特异性为 39.2%，阳性预测值为 47.8%，阴性预测值为 97.4%，准确性为 60.5%。接受者操作特征（ROC）曲线下面积（AUC）分析评估表明，测量尿胱抑素 C 水平可有效区分新生儿的肾脏损伤与正常肾脏情况（AUC=0.868，95%CI：0.811-0.925，P＜0.001）。预测肾脏损伤的最佳尿胱抑素 C 水平截断值为 41.5mmol/mol 肌酐，其灵敏度为 98.2%，特异性为 46.4%。