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目的:探讨血清胱抑素C(sCysC)预测神经重症患者发生急性肾损伤(acute kidney injury,AKI)临床价值。方法:前瞻性入选2015-03-2015-12入住南方医科大学附属小榄医院重症医学科(ICU)的110例神经重症患者。以KDIGO标准为诊断标准,将患者分为非AKI组和AKI组,比较各组患者sCysC及血肌酐(sCr)水平。运用受试者工作特征(ROC)曲线及曲线下面积(AUC)评价sCysC对AKI的诊断和短期预后的预测价值。结果:110例患者中有39例发生AKI,AKI发生率为35.5%。AKI组患者sCysC水平明显高于非AKI组,差异有统计学意义(P<0.05)。sCysC预测AKI和重症AKI的AUC分别为0.946和0.936,预测肾脏替代治疗的AUC为0.952。本研究队列中,住院死亡率为12.7%,肾脏替代治疗率为4.5%,AKI组的住院死亡率及肾脏替代治疗率均明显高于非AKI组(均P<0.05)。结论:sCysC是预测神经重症患者发生AKI及预后的可靠指标,并且提供判断患者短期预后的相关信息。
Objective: To investigate the clinical value of serum cystatin C (sCysC) in predicting acute kidney injury (AKI) in patients with neurosis. METHODS: We prospectively selected 110 neurotic patients with ICU admitted to the Siu Lam Hospital Affiliated to Southern Medical University for 2015-03-2015-12. Patients were divided into non-AKI group and AKI group according to KDIGO criteria. The levels of sCysC and serum creatinine (sCr) in each group were compared. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the predictive value of sCysC in AKI diagnosis and short-term prognosis. Results: Of the 110 patients, 39 developed AKI and the incidence of AKI was 35.5%. The level of sCysC in AKI group was significantly higher than that in non-AKI group (P <0.05). The AUC of sCysC predicting AKI and severe AKI were 0.946 and 0.936, respectively. The AUC of renal replacement therapy was 0.952. In our cohort, in-hospital mortality was 12.7% and renal replacement therapy was 4.5%. Both in-hospital mortality and renal replacement therapy were significantly higher in the AKI group than in the non-AKI group (all P <0.05). CONCLUSIONS: sCysC is a reliable predictor of AKI and prognosis in patients with neuroticism and provides information to determine short-term prognosis in patients.