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目的:探讨血清胱抑素C(CysC)及其估算肾小球滤过率(eGFR)在肝肾综合征(HRS)诊断中的应用价值。方法:测定218例肝硬化腹水患者的血清CysC和肌酐(Cr)浓度,并采用CKD-EPI 2012 Cr-CysC方程计算其eGFR,分析三者在非HRS和各型HRS患者中的差异,并初步探索血清Cr和eGFR的判断阈值及其在HRS患者中的检出率。结果:血清CysC和Cr间增长倍数的关系方程为:CysC增长倍数=0.608+0.631×Cr增长倍数(R2=0.640,P<0.001)。与Cr增长倍数相比,CysC增长倍数在非HRS患者中明显增高(Z=-10.133,P<0.001),在HRS-1型患者中明显降低(Z=2.725,P=0.006),而在HRS-2型患者中二者的差异无统计学意义(Z=0.715,P=0.474)。以血清Cr和CysC浓度超过基线水平1.5倍,eGFR超过60 mL/min/1.73m2为阳性标准,在非HRS组中,CysC和eGFR的阳性检出率高于Cr,差异均有统计学意义(P<0.001);在HRS组中,CysC的阳性检出率低于Cr,差异有统计学意义(P<0.001),而eGFR阳性检出率与Cr相当;所有肝硬化伴腹水患者中,eGFR的阳性检出率明显高于Cr(P=0.002)。结论:血清CysC和eGFR测定能有助于早期诊断亚临床HRS。相对Cr而言,血清CysC对HRS-2患者不能提供更好的检出率,而且对HRS-1患者会低估其肾功能。
Objective: To investigate the value of serum cystatin C (CysC) and its estimated glomerular filtration rate (eGFR) in the diagnosis of hepatorenal syndrome (HRS). Methods: Serum CysC and creatinine (Cr) levels in 218 patients with cirrhosis were measured. The eGFR was calculated by CKD-EPI 2012 Cr-CysC equation. The differences among the three groups in patients with non-HRS and various HRS were analyzed. To explore the determination of serum Cr and eGFR threshold and its detection rate in patients with HRS. Results: The relationship between the growth of serum CysC and Cr was as follows: CysC multiplied by 0.608 + 0.631 × Cr (R2 = 0.640, P <0.001). The fold increase of CysC was significantly higher than that of Cr (Z = -10.133, P <0.001) in non-HRS patients and significantly lower in patients with HRS-1 (Z = 2.725, P = 0.006) There was no significant difference between the two groups (Z = 0.715, P = 0.474). The positive rate of CysC and eGFR was higher than that of Cr in non-HRS group, with serum Cr and CysC concentration exceeding 1.5 times the baseline level and eGFR exceeding 60 mL / min / 1.73m 2 P <0.001). The positive rate of CysC in HRS group was lower than that in Cr group (P <0.001), while the positive rate of eGFR was the same as that in Cr group. In all patients with cirrhosis and edema, eGFR The positive detection rate was significantly higher than Cr (P = 0.002). Conclusion: Serum CysC and eGFR can be helpful for the early diagnosis of subclinical HRS. Relative to Cr, serum CysC did not provide a better detection rate for HRS-2 patients and underestimated renal function in HRS-1 patients.