胱抑素C在肝移植术后急性肾损伤患者中的研究

Cystatin C in Patients with Acute Kidney Injury after Liver Transplantation

摘要: 目的：探讨胱抑素C (CysC)在肝移植术后患者急性肾损伤(AKI)早期诊断中的价值。方法：回顾性分析青岛大学附属医院肝脏移植科2018年1月~2019年1月行肝脏移植术的术前肾功能正常患者的临床资料。应用改善全球肾脏病预后组织(KDIGO) 2012年修订的AKI诊断和分期标准，并根据肝移植术后是否发生AKI将患者分为两组：急性肾损伤和非急性肾损伤组。收集术前患者一般资料以及术前、术后第1、2、3天CysC数值，采用ROC曲线评价Cys C对肝移植术后急性肾损伤的诊断价值。结果：本研究共纳入110例肝移植患者，术后57例发生AKI (51.8%)。结果显示，急性肾损伤组术前及术后第1、2、3天Cys C数值与对照组比较，有统计学差异。ROC曲线结果显示，采用术前Cys C为早期诊断指标，Cys C的最佳截断值为0.98 mg/L。结论：Cys C可作为术前肾功能正常患者肝移植术后发生急性肾损伤的内源性标志物。对于术前Cys C增高的患者，应注意预防术后急性肾损伤的发生。

Abstract: Objective: To investigate the value of Cys C in the early diagnosis of acute kidney injury after liver transplantation. Method: To retrospectively analyze the clinical data of patients with normal renal function who underwent liver transplantation in the Department of liver transplantation, Affiliated Hospital of Qingdao University from January 2018 to January 2019. According to the diagnostic and staging criteria of AKI revised by the global organization for improving the prognosis of kidney disease (KDIGO) in 2012, the patients were divided into two groups: acute kidney injury group and non acute kidney injury group. The general data of patients before operation and serum CysC values before operation and on the 1st, 2nd and 3rd day after operation were collected. The diagnostic value of CysC for acute kidney injury after liver transplantation was evaluated by ROC curve. Result: A total of 110 patients with liver transplantation were included in this study. AKI occurred in 57 patients (51.8%). The results showed that there were significant differences in Cys C values between the acute kidney injury group and the control group before operation and on the 1st, 2nd and 3rd day after operation. ROC curve results showed that the optimal cut-off value of Cys C was 0.98 mg/L using preoperative Cys C as an early diagnostic index. Conclusion: Cys C can be used as an endogenous marker of acute kidney injury in patients with normal preoperative renal function after liver transplantation. We should pay attention to the prevention of postoperative acute kidney injury in patients with preoperative cystatin increase.