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目的探讨血清半胱氨酸蛋白酶抑制剂C(Cys C)对肝硬化患者肾功能早期损害的诊断价值。方法测定67例肝硬化患者和32名健康对照者的血清肌酐(Cr)、尿素(Urea)、肌酐清除率(Ccr)和Cys C水平,并将患者按性别、Ch ild-Pugh分级或Ccr水平进行分组评价。结果肝硬化患者血清Ccr和Cys C水平与对照组比较差异有显著性(P<0.001),但Cr和Urea差异无显著性。不同性别患者Ccr、Cr和Cys C水平与对照组比较差异有显著性(P<0.05~0.001),但Urea无差异。肝硬化患者Ch ild-Pugh分级各亚组Ccr、Cr、Urea和Cys C水平与健康对照组比较差异有显著性(P<0.05~0.001)。以Ccr 70 m l/m in为界点将患者分为Ⅰ和Ⅱ亚组,并与对照组比较,结果表明仅Cys C水平差异有显著性(P<0.001),Cys C水平Ⅰ和Ⅱ2亚组间差异也有显著性(P<0.001)。受试者工作特征曲线(ROC曲线)显示Cys C诊断有效性优于Cr和Urea。结论血清Cr和Urea难以对肝硬化患者肾功能轻度受损进行诊断,Ccr虽能作出早期指示,却过高估计试验结果,而Cys C能较准确地作出早期检测,提示其可能是潜在的肝硬化患者肾功能早期损害的指标。
Objective To investigate the diagnostic value of serum cystatin C (Cys C) in early stage renal damage in patients with liver cirrhosis. Methods Serum creatinine (Cr), urea (Urea), creatinine clearance (Ccr) and Cys C levels were measured in 67 patients with cirrhosis and 32 healthy controls. The patients were classified by sex, Child-Pugh score or Ccr level Group evaluation. Results The serum levels of Ccr and Cys C in patients with cirrhosis were significantly different from those in the control group (P <0.001), but there was no significant difference between Cr and Urea. The levels of Ccr, Cr and Cys C in different genders were significantly different from those in control group (P <0.05 ~ 0.001), but there was no difference in Urea. The levels of Ccr, Cr, Urea and Cys C in Child-Pugh grading subgroups of patients with cirrhosis were significantly different from those in healthy controls (P <0.05-0.001). Patients were divided into subgroups Ⅰ and Ⅱ according to Ccr 70 ml / m in. Compared with control group, the results showed that there was significant difference only in Cys C level (P <0.001), Cys C level Ⅰ and Ⅱ subgroup There was also a significant difference between the two groups (P <0.001). The receiver operating characteristic curve (ROC curve) showed that Cys C was more effective than Cr and Urea in diagnosis. Conclusions Serum Cr and Urea are difficult to diagnose mild renal impairment in patients with cirrhosis. Although Ccr can give early indications, it overestimates the test results, while Cys C can make early detection more accurately, suggesting that it may be potential Index of early renal damage in cirrhotic patients.