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目的探讨ICU急性肾损伤(AKI)患者血清中胱抑素C(cystatin C)与急性病理生理学和慢性健康评价(APACHE)Ⅱ评分的关联性,初步评价两者在ICUAKI患者中的预后价值。方法选取2010年6月至2011年5月该院ICU收治的32例AKI患者(AKI组)的血液标本,均符合AKI诊断标准。记录其cystatin C的变化,同时收集临床资料,包括性别,年龄,慢性疾病史,24h内各种化验指标(血常规、血气分析、肾功能、血电解质等)的最差值,并对其进行APACHEⅡ评分。AKI组分为存活组和死亡组,另外选取同期入住ICU未发生AKI患者20例作为非AKI组。结果 32例AKI组患者,死亡11例,死亡率34.4%。cystatin C水平随APACHEⅡ评分增多而升高,存活组与死亡组之间比较差异有统计学意义(P<0.05),Logistic回归分析显示cystatin C升高结合APACHEⅡ≥15分,少尿与AKI患者死亡率密切相关(P<0.05)。结论对ICU AKI患者进行综合治疗的前提下,cystatin C升高结合APACHEⅡ评分≥15分可以作为评价AKI患者预后的指标。
Objective To investigate the correlation between serum cystatin C and acute pathophysiology and chronic health evaluation (APACHE) Ⅱ score in ICU patients with acute renal injury (ICI) and to evaluate its prognostic value in patients with ICUAKI. Methods Blood samples from 32 patients with AKI (AKI group) admitted to ICU from June 2010 to May 2011 were all eligible for AKI diagnostic criteria. Record the changes of cystatin C, and collect the clinical data, including the gender, age, history of chronic diseases, the worst value of various laboratory indicators (blood routine, blood gas analysis, renal function, blood electrolytes, etc.) within 24 hours APACHE Ⅱ score. The AKI group was divided into survival group and death group. Twenty patients without AKI in ICU during the same period were selected as non-AKI group. Results 32 cases of AKI patients, 11 patients died, the mortality rate was 34.4%. The level of cystatin C increased with the increase of APACHEⅡscore, and there was significant difference between survival group and death group (P <0.05). Logistic regression analysis showed that cystatin C increased with APACHEⅡ≥15, and oliguria and AKI died Rate is closely related (P <0.05). Conclusion ICU AKI patients under the premise of comprehensive treatment, cystatin C elevated APACHE Ⅱ score ≥ 15 points can be used as an index to evaluate the prognosis of patients with AKI.