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目的建立血清半胱氨酸蛋白酶抑制物C(CystatinC,CysC)的定量ELISA检测方法,探讨血清CysC水平在肝肾综合征(HRS)早期诊断中的价值。方法用ELISA法测定81例常规检查肾功能正常的肝硬化患者和26例健康体检者的血清CysC水平,同时检测其血肌酐(Scr)、尿素氮(BUN)及尿肌酐(Ucr),算出校正24h肌酐清除率(Ccr)作为肾小球滤过率标准,40≤Ccr<80ml·min-1·1.73m-2的肝硬化患者被列为亚临床HRS组。结果亚临床HRS组血清CysC浓度明显高于单纯肝硬化组(P<0.05);而Scr、BUN在两组的差别无统计学意义。CysC与Ccr相关性比Scr与Ccr相关性好(r=-0.91对r=-0.72,P<0.05);受试者工作特征曲线(ROC)分析显示CysC曲线优于Scr。结论血清CysC较Scr、BUN能更敏感地检测出肝硬化患者的轻度肾功能损害,可作为识别亚临床HRS的一项新指标。
Objective To establish a quantitative ELISA for the detection of serum Cystatin C (CysC), and to explore the value of serum CysC in the early diagnosis of hepatorenal syndrome (HRS). Methods Serum levels of CysC in 81 patients with cirrhosis and 26 healthy controls were measured by ELISA. Serum creatinine (Scr), blood urea nitrogen (BUN) and urinary creatinine (Ucr) were measured at the same time to calculate the corrected 24h creatinine clearance (Ccr) as a standard glomerular filtration rate, 40 ≤ Ccr <80ml · min-1 · 1.73m-2 of cirrhosis patients were classified as subclinical HRS group. Results The level of serum CysC in subclinical HRS group was significantly higher than that in cirrhosis group (P <0.05). There was no significant difference in Scr and BUN between the two groups. The correlation between CysC and Ccr was better than Scr and Ccr (r = -0.91 vs r = -0.72, P <0.05). The receiver operating characteristic curve (ROC) analysis showed that the CysC curve was superior to Scr. Conclusions Serum CysC is more sensitive than Scr and BUN in detecting mild renal impairment in patients with cirrhosis and may be used as a new indicator to identify subclinical HRS.