發(fā)布時(shí)間：2017-12-28 11:29

  本文關(guān)鍵詞：血清胱抑素C濃度對(duì)急性心力衰竭合并急性腎損傷的早期識(shí)別價(jià)值　出處：《廣西醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 胱抑素C 急性心力衰竭 急性腎功能損害 B型腦利鈉肽

【摘要】：目的 通過檢測(cè)血清胱抑素C(Cys-C)水平,觀察其在急性心力衰竭(AHF)發(fā)生后的濃度變化,探討Cys-C對(duì)急性心力衰竭合并急性腎損傷(Acute Kidney Injury, AKI)的早期識(shí)別價(jià)值。方法 回顧性分析2009年1月1日至2015年12月31日在廣西醫(yī)科大學(xué)第一附屬醫(yī)院住院的125例資料完整的急性心力衰竭且符合納入標(biāo)準(zhǔn)的患者,以入院72小時(shí)為觀測(cè)時(shí)間終點(diǎn),按KDIGO診斷AKI,檢測(cè)急性心力衰竭患者入院時(shí)、入院后第1天、第2天、第3天的血清Cys-C、Cr與BNP的濃度。采用Spearman相關(guān)系數(shù)分析Cys-C與B型腦利鈉肽(Brain Natriuretic Peptide, BNP)的相關(guān)性。采用Wilcoxon秩和檢驗(yàn)比較單純急性心力衰竭組(對(duì)照組)和AKI組(病例組)四個(gè)不同時(shí)間Cys-C、Cr、 BNP水平之間的差異,P0.05為差異有統(tǒng)計(jì)學(xué)意義,病例組組間比較采用Nemenyi秩和檢驗(yàn),P0.05為差異有統(tǒng)計(jì)學(xué)意義。采用配對(duì)四格表x2檢驗(yàn)比較兩種指標(biāo)診斷AKI的發(fā)生率,P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果對(duì)照組和病例組患者在基線資料上比較差異無統(tǒng)計(jì)學(xué)意義(P均0.05)。Spearman相關(guān)分析,結(jié)果顯示,Cys-C、Cr與BNP呈正相關(guān),P0.05,且Cys-C比Cr的相關(guān)程度高(第1天、第2天、第3天Cys-C的r值分別為0.537、0.635、0.744,Cr的r值分別為0.445、0.528、0.650)。急性心力衰竭發(fā)生后對(duì)照組、病例組患者血清Cys-C、Cr、BNP水平隨著時(shí)間的推移而升高,病例組的Cys-C、Cr、BNP,不同時(shí)間兩兩比較,P0.05,差別有統(tǒng)計(jì)學(xué)意義。在病例組中,根據(jù)KDIGO的標(biāo)準(zhǔn)作為判斷指標(biāo),急性心力衰竭發(fā)作后第1天、第2天、第3天,若以Cys-C大于1.03mg/L作為AKI的判斷指標(biāo),Cys-C診斷AKI的發(fā)生率分別為25/51(49.0%),42/51(82.4%),51/51(100%)；而Cr診斷AKI的發(fā)生率分別為13/51(25.5%),28/51(54.9%),51/51(100%)。第1天、第2天兩者的發(fā)生率比較,P0.05,差別有統(tǒng)計(jì)學(xué)意義；第3天兩者的發(fā)生率比較,P0.05,差別無統(tǒng)計(jì)學(xué)意義。說明Cys-C在急性心力衰竭發(fā)生2天內(nèi)比Cr能發(fā)現(xiàn)更多的AKI患者,提示Cys-C在2天內(nèi)診斷急性心力衰竭合并AKI有一定的預(yù)警價(jià)值,且診斷效能優(yōu)于Cr。結(jié)論對(duì)急性心力衰竭患者,Cys-C比Cr能更早檢測(cè)AKI發(fā)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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R541.6;R692

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