目的 研究血肌酐联合胱抑素C诊断急性肾损伤(AKI)的临床价值.方法 回顾性分析7627例住院患者临床资料.根据全球肾脏病预后组织(KDIGO)标准分别用肌酐或胱抑素C判断有无AKI.结果 最高血胱抑素C水平和肌酐值显著相关(Spearman相关系数0.699,P<0.001).最高胱抑素C水平预测院内死亡的受试者工作特征曲线下面积0.761(95%可信区间0.693~0.828).符合血肌酐和胱抑素C标准的AKI分别有1004例(13.2%)和173例(2.3%).血肌酐联合胱抑素C判断AKI,1119例(14.7%)发生AKI.在多变量Logistic回归模型中,和血肌酐(-)胱抑素C(-)组比较,血肌酐(-)胱抑素(+)显著增加死亡的风险(OR值15.524,95%可信区间5.110~47.166).结论 联合胱抑素C能提高血肌酐诊断AKI的敏感性,有助于识别高危住院人群.%Objective We aimed to investigate the clinical values of combination of blood creatinine and cystatin C for acute kidney injury(AKI)diagnosi. Methods Total 7 627 patients were studied retrospectively. The AKI was classified by creatinine or cystatin C according to the Kidney Disease:Improving Global Outcomes criteria. Results The maximum levels of cystatin C and creatinine were correlated(Spearman′s rank coefficient 0.699,P < 0.001). The area under a receiver operating characteristic curve of maximum cystatin C value for pre-dicting in-hospital death was 0.761(95% confidence interval 0.693 ~ 0.828). Total 1 004 and 173 patients were classified into AKI by blood creatinine or by cystatin C(13.2% vs.2.3%,P<0.001),respectively.The total inci-dence of AKI was 14.7% diagnosed by the combination of the two markers.In multivariable logistic model,the cre-atinine negative plus cystatin C positive group was associated with a higher in-hospital death compared with the cre-atinine and cystatin C double negative group(OR 15.524,95% confidence interval 5.110 ~ 47.166,P < 0.001). Conclusion Combination of cystatin C increased sensitivity of creatinine for AKI diagnosis and facilitated to iden-tify in-hospital patients with high risk.
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