血清胱抑素C与肌酐水平评估不停跳冠脉旁路移植术后急性肾损伤的临床意义-现代医学

血清胱抑素C与肌酐水平评估不停跳冠脉旁路移植术后急性肾损伤的临床意义

单位：西安交通大学第一附属医院心血管外科, 陕西西安 710061

分类号：R541;R655;R692

出版年·卷·期（页码）：2018·46·第三期（263-267）

摘要：

目的：探讨血清胱抑素C （SCys-C）及血肌酐（Scr）水平评估不停跳冠脉旁路移植术（OPCABG）术后急性肾损伤（AKI）的临床意义。方法：选取从2015年1月至2017年1月我院166例择期行OPCABG患者，根据AKI诊断标准分为AKI组和非AKI组。检测两组患者术前、术后SCys-C及Scr浓度，应用公式估算肾小球滤过率（eGFR）。分析AKI组术后SCys-C与Scr及eGFR之间的相关性，应用受试者工作曲线（ROC曲线）评价术后SCys-C、Scr预测OPCABG术后AKI的诊断价值。结果：术后SCys-C与Scr具有线性正相关性（r=0.643，P<0.05），术后Scr与eGFR呈线性负相关（r=-0.214，P<0.05），而SCys-C与eGFR无相关性（r=-0.103，P>0.05）；术后SCys-C与Scr的ROC曲线分析提示：AUC为0.704，P<0.05，95% CI为0.590~0.818 vs AUC为0.854，P<0.05，95% CI为0.765~0.942，约登指数为0.660，敏感度为89%，特异度为77%。结论：SCys-C可用于早期预测OPCABG术后AKI发生，而Scr的诊断效能更佳。

Objective: To investigate the clinical significance of serum cystatin C(SCys-C) and serum creatinine (Scr) in evaluating acute kidney injury(AKI) after off-pump coronary artery bypass grafting(OPCABG).Methods: From January 2015 to January 2017, 166 patients undergoing OPCABG in our hospital were enrolled. According to the diagnostic criteria of AKI, the patients were divided into AKI group and non-AKI group.Preoperative and postoperative SCys-C and creatinine(Scr) concentrations were measured in both groups. The formula was used to estimate the glomerular filtration rate(eGFR). The correlation among SCys-C, Scr and eGFR in AKI group was analyzed.The ROC curve was used to evaluate the diagnostic value of postoperative SCys-C and Scr in predicting the occurrence of AKI after OPCABG. Results: There was a linear positive correlation between SCys-C and Scr postoperatively (r=0.643,P<0.05). There was a negative correlation between Scr and eGFR postoperatively (r=-0.214,P<0.05). However, the negative correlation between SCys-C and eGFR was not significant (r=-0.103,P>0.05); ROC curve analysis of postoperative SCys-C and Scr showed as follows:AUC 0.704, P<0.05, 95% CI (0.590-0.818) of SCys-C vs AUC 0.854, P<0.05,95% CI(0.765-0.942) of Scr, Youden index 0.660, Sensitivity 89%, specificity 77%.Conclusion: SCys-C can be used to predict the occurrence of AKI after OPCABG in the early stage. However, Scr has better diagnostic efficacy.

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