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目的了解胱抑素C(SCys-C)在儿童先天性心脏病介入封堵术相关造影剂致急性肾损伤中的诊断价值。方法选择2013年四川大学华西第二医院介入封堵术的先天性心脏病患儿(室间隔缺损、动脉导管未闭)128例,于术前,术后24h、48h分别抽血检测尿素氮(BUN)、血清肌酐(SCr)和SCys-C等。根据急性肾损伤(AKI)网络的AKI诊断标准,将AKI患儿分为肾功能1期和肾功能2期,比较AKI患儿(n=16)和非AKI患儿(n=112)之间及不同分期AKI患儿之间的肾功能指标及SCys-C浓度差异。采用受试者工作特征(ROC)曲线计算SCys-C诊断儿童急性肾损伤的临界点。结果 AKI组的SCr、SCys-C高于非AKI组(P<0.05),BUN表达两组比较差异无统计学意义(P>0.05)。肾功能1期与肾功能2期患者比较仅SCys-C的表达差异有统计学意义(P<0.05)。根据曲线下面积(AUC)判断,SCys-C于术后24h即可发现AKI的发生(P<0.05),术后24h的SCys-C临界值在1.055mg/L可获得最大约登指数。术后48h的SCys-C的AUC与术后24h差异无统计学意义,诊断价值相当(P>0.05)。术后24h的SCr不能发现AKI的发生(P>0.05),但术后48h可发现AKI(P<0.05)。同时点比较,SCys-C诊断价值均优于SCr,差异有统计学意义(P<0.05)。结论儿童先天性心脏病介入封堵术相关造影剂可增加儿童急性肾损伤的风险,SCys-C是其重要筛选指标之一并有助于早期诊断,其术后24h的临界值为1.055mg/L。
Objective To investigate the diagnostic value of cystatin C (SCys-C) in acute renal injury induced by concomitant contrast media in children with congenital heart disease. Methods 128 cases of congenital heart disease (ventricular septal defect, patent ductus arteriosus) with occlusion in Huaxi No.2 Hospital of Sichuan University in 2013 were enrolled in this study. Blood samples were taken before and 24 h and 48 h after operation respectively to detect blood urea nitrogen BUN), serum creatinine (SCr) and SCys-C. According to the AKI diagnostic criteria of acute kidney injury (AKI) network, children with AKI were divided into 1 stage of renal function and 2 stage of renal function. The difference between children with AKI (n = 16) and children without AKI (n = 112) And AKI children with different stages of renal function and SCys-C concentration differences. Using the receiver operating characteristic (ROC) curve to calculate the critical point of SCys-C diagnosis of acute kidney injury in children. Results The SCr and SCys-C in AKI group were significantly higher than those in non-AKI group (P <0.05). There was no significant difference in BUN expression between the two groups (P> 0.05). There was significant difference in the expression of SCys-C between the first stage of renal function and the second stage of renal function (P <0.05). According to the area under the curve (AUC), the occurrence of AKI was found at 24 h after SCys-C (P <0.05), and the maximum Youden index was obtained at the SCys-C cut-off value of 1.055 mg / L at 24 h after surgery. There was no significant difference in AUC of SCys-C at 48h after operation and 24h after operation, and the diagnostic value was similar (P> 0.05). The occurrence of AKI was not found at 24 hours after operation (P> 0.05), but AKI was found at 48 hours after operation (P <0.05). At the same time point, the diagnostic value of SCys-C was better than SCr, the difference was statistically significant (P <0.05). Conclusion The interventional congenital heart disease in children with congenital heart disease can increase the risk of acute kidney injury, SCys-C is one of the important screening indicators and contribute to the early diagnosis, the critical value of 24h after surgery was 1.055mg / L.