Serum cystatin C level is a good prognostic marker in patients with cirrhotic ascites and normal serum creatinine levels
Serum cystatin C level is a good prognostic marker in patients with cirrhotic ascites and normal serum creatinine levels
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DOI：
10.1111/j.1478-3231.2009.02105.x
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发表时间：
2009-11-01
影响因子：
6.7
通讯作者：
Um, Soon Ho
中科院分区：
文献类型：
--
作者：
Seo, Yeon Seok;Jung, Eun Suk;Um, Soon Ho
背景/目的血清肌酐（Cr）不是诊断腹水患者肾功能不全的可靠指标。一些报告表明，半胱氨酸蛋白酶抑制剂C（CysC）比Cr更敏感，用于检测这些患者的肾功能下降。本研究评估了CysC在腹水患者和正常血清Cr level.MethodsWe纳入腹水患者和正常血清Cr水平（< 1.2 mg/dl）的临床意义。所有患者均于当天进行肝功能检查、国际标准化比值（INR）、血清肌酐（Cr）和胱抑素C（CysC）水平测定。CysC水平的测定使用自动化乳胶增强免疫荧光法。随访的终点是肝肾综合征（HRS）或mortality. ResultsSeventy-e8例腹水患者参加了这项研究（58名男性和30名女性，年龄，53 +/- 11岁）的发展。这些患者的基础肝病为慢性B肝炎（37%）、慢性丙型肝炎（4%）、酒精性肝病（53%）和其他（6%）。Child-Pugh分级分别为B级和C级的患者分别为46例（59%）和32例（41%）。随访期间（349 ± 241天），14例患者发生HRS，6个月和12个月时的累积发生率分别为10.2%和20.4%。CysC水平是HRS的唯一独立预测因素。23例患者在随访期间死亡。结论血清CysC水平是预测Cr正常的腹水患者HRS和生存的良好指标。
Background/AimsSerum creatinine (Cr) is not a reliable marker for early detection of renal dysfunction in patients with cirrhotic ascites. Several reports have suggested that cystatin C (CysC) is more sensitive than Cr for detecting reduced renal function in these patients. This study evaluated the clinical significance of CysC in patients with cirrhotic ascites and a normal serum Cr level.MethodsWe enrolled patients with ascites and a normal serum Cr level (< 1.2 mg/dl). Liver function tests, international normalized ratio (INR) and serum Cr and CysC levels were measured on the same day for all patients. CysC levels were measured using the automated latex-enhanced immunonephelometric method. The endpoint of follow-up was the development of hepatorenal syndrome (HRS) or mortality.ResultsSeventy-eight patients with cirrhotic ascites were enrolled in the study (58 men and 30 women; age, 53 +/- 11 years). The underlying liver diseases in these patients were chronic hepatitis B (37%), chronic hepatitis C (4%), alcoholic liver disease (53%) and others (6%). Forty-six (59%) and 32 (41%) patients were in Child-Pugh classes B and C respectively. HRS developed in 14 patients during the follow-up period (349 +/- 241 days), with cumulative incidences of 10.2% and 20.4% at 6 and 12 months respectively. The CysC level was the only independent predictive factor for HRS. Twenty-three patients died during the follow-up period. CysC level and INR were independent factors for predicting mortality.ConclusionSerum CysC level is a good marker for predicting HRS and survival in patients with cirrhotic ascites and a normal Cr level.