血清胱抑素C浓度对急性心力衰竭合并急性肾损伤的早期识别价值

发布时间：2017-12-28 11:29

本文关键词：血清胱抑素C浓度对急性心力衰竭合并急性肾损伤的早期识别价值　出处：《广西医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的通过检测血清胱抑素C(Cys-C)水平,观察其在急性心力衰竭(AHF)发生后的浓度变化,探讨Cys-C对急性心力衰竭合并急性肾损伤(Acute Kidney Injury, AKI)的早期识别价值。方法回顾性分析2009年1月1日至2015年12月31日在广西医科大学第一附属医院住院的125例资料完整的急性心力衰竭且符合纳入标准的患者,以入院72小时为观测时间终点,按KDIGO诊断AKI,检测急性心力衰竭患者入院时、入院后第1天、第2天、第3天的血清Cys-C、Cr与BNP的浓度。采用Spearman相关系数分析Cys-C与B型脑利钠肽(Brain Natriuretic Peptide, BNP)的相关性。采用Wilcoxon秩和检验比较单纯急性心力衰竭组(对照组)和AKI组(病例组)四个不同时间Cys-C、Cr、 BNP水平之间的差异,P0.05为差异有统计学意义,病例组组间比较采用Nemenyi秩和检验,P0.05为差异有统计学意义。采用配对四格表x2检验比较两种指标诊断AKI的发生率,P0.05为差异有统计学意义。结果对照组和病例组患者在基线资料上比较差异无统计学意义(P均0.05)。Spearman相关分析,结果显示,Cys-C、Cr与BNP呈正相关,P0.05,且Cys-C比Cr的相关程度高(第1天、第2天、第3天Cys-C的r值分别为0.537、0.635、0.744,Cr的r值分别为0.445、0.528、0.650)。急性心力衰竭发生后对照组、病例组患者血清Cys-C、Cr、BNP水平随着时间的推移而升高,病例组的Cys-C、Cr、BNP,不同时间两两比较,P0.05,差别有统计学意义。在病例组中,根据KDIGO的标准作为判断指标,急性心力衰竭发作后第1天、第2天、第3天,若以Cys-C大于1.03mg/L作为AKI的判断指标,Cys-C诊断AKI的发生率分别为25/51(49.0%),42/51(82.4%),51/51(100%)；而Cr诊断AKI的发生率分别为13/51(25.5%),28/51(54.9%),51/51(100%)。第1天、第2天两者的发生率比较,P0.05,差别有统计学意义；第3天两者的发生率比较,P0.05,差别无统计学意义。说明Cys-C在急性心力衰竭发生2天内比Cr能发现更多的AKI患者,提示Cys-C在2天内诊断急性心力衰竭合并AKI有一定的预警价值,且诊断效能优于Cr。结论对急性心力衰竭患者,Cys-C比Cr能更早检测AKI发生。
[Abstract]:Objective to detect the level of serum cystatin C (Cys-C) and observe its concentration changes after acute heart failure (AHF), and to explore the early recognition value of Cys-C for Acute Kidney Injury (AKI). Methods a retrospective analysis of patients who met the inclusion criteria from January 1, 2009 to December 31, 2015 in the First Affiliated Hospital of Guangxi Medical University, the complete clinical data of 125 patients with acute heart failure and, in 72 hours of admission for observation time end point, according to the KDIGO diagnosis of AKI, the concentration detection of acute heart failure patients after admission and first days, second days, third, serum Cys-C the days of Cr and BNP. The correlation between Cys-C and B type natriuretic peptide (Brain Natriuretic Peptide, BNP) was analyzed by Spearman correlation coefficient. Compared with Wilcoxon rank sum test of acute heart failure group (control group) and group AKI (case group) the difference between the four different time of Cys-C, Cr, BNP, P0.05 there was a statistically significant difference were compared between groups using Nemenyi rank sum test, the difference was statistically significant P0.05. A paired four lattice x2 test was used to compare the incidence of AKI in the diagnosis of the two indexes, and the difference in P0.05 was statistically significant. Results there was no significant difference in baseline data between the control group and the case group (P 0.05). Spearman correlation analysis showed that Cys-C and Cr were positively correlated with BNP, P0.05, and Cys-C was higher than Cr (first days, second days, third days) r value of Cys-C was 0.537, 0.635, 0.744, Cr r value was 0.445, 0.528, 0.650, respectively. After acute heart failure, serum Cys-C, Cr and BNP levels in the control group and case group increased as time went on. The Cys-C, Cr and BNP in case group were 22 times P0.05, the difference was statistically significant. In case group, according to the KDIGO standard as the judgment index, first days after the onset of acute heart failure, second days, third days, if the Cys-C is greater than 1.03mg/L as the evaluation index of AKI, Cys-C in the diagnosis of AKI were 25/51 (49%), 42/51 (82.4%), 51/51 (100%); and Cr for the diagnosis of AKI the incidence rate was 13/51 (25.5%), 28/51 (54.9%), 51/51 (100%). The incidence of both first days and second days was compared, P0.05, the difference was statistically significant; the third days of the incidence of both, P0.05, the difference was not statistically significant. It indicates that Cys-C can find more AKI patients in the 2 days after the onset of acute heart failure than Cr. It indicates that Cys-C has a certain early warning value in diagnosing acute heart failure and AKI within 2 days, and the diagnostic efficiency is better than Cr. Conclusion in patients with acute heart failure, Cys-C can detect the occurrence of AKI earlier than Cr.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.6;R692

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