| 马 聪,卢 迪,栾军军,王冬冬,冉孟萍,周 华.血清胱抑素C作为新型肾功指标在狼疮肾炎中的临床意义[J].,2020,(16):3050-3056 |
| 血清胱抑素C作为新型肾功指标在狼疮肾炎中的临床意义 |
| Clinical Significance of sCysC as A New Renal Function Evaluation Index in Lupus Nephritis |
| 投稿时间：2019-12-29 修订日期：2020-01-24 |
| DOI：10.13241/j.cnki.pmb.2020.16.010 |
| 中文关键词: 系统性红斑狼疮 狼疮肾炎 胱抑素C 诊断治疗标志物 |
| 英文关键词: Systemic lupus erythematosus Lupus nephritis Cystatin C Diagnostic-therapeutic biomarker |
| 基金项目:国家自然科学基金面上项目(81770698, 81370835)；辽宁省重点研发指导计划项目(2019JH8/10300009)；辽宁省攀登学者资助项目(2013222) |
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| 中文摘要: |
| 摘要 目的：探讨血清胱抑素C在狼疮肾炎的诊断及治疗监测中的临床意义。方法：检测106名狼疮肾炎患者的血清胱抑素C(sCysC)、血清肌酐(sCr)、尿素氮(BUN)、肾小球滤过率(GFR)，24小时尿蛋白(uTP)、血清白蛋白(sAlb)、C-反应蛋白(CRP)水平，分析sCysC与上述指标的相关性及其在治疗过程中的动态变化，并与传统肾功能指标(sCr、BUN)进行比较。结果：①治疗前，血清sCysC水平与uTP、sAlb、SLEDAI、CRP均显著相关，且优于sCr及BUN。②治疗中，血清sCysC水平与uTP、sAlb的相关性均优于sCr及BUN。③血清sCysC水平随激素及免疫抑制剂治疗显著改善，这一趋势见于BUN并未见于Scr；激素及CTX治疗结束后，血清sCysC水平显著改善，这一趋势见于Scr并未见于BUN。④治疗前，sCr与sCysC联合计算所得eGFR与各项指标相关性最高。结论：sCysC在狼疮肾炎早期肾损害诊断、治疗过程以及监测疗效的敏感性均优于传统sCr和BUN。sCysC单独及sCysC联合sCr计算的GFR均优于单独sCr计算获得的GFR。sCysC在LN中不仅可作为肾功能的新型评价标志物，可能也作为炎症反应的标志物。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the clinical significance of sCysC in the diagnosis, treatment and monitoring of lupus nephritis. Methods: 106 patients with lupus nephritis confirmed by renal biopsy were selected from the department of Nephrology of affiliated Hospital of China Medical University from May 2007 to December 2014. The renal function indexes (sCysC, sCr, BUN, GFR), nephritis activity indexes (uTP, sAlb), systemic disease activity indexes (SLEDAI), immune inflammatory response indexes (C3, C4, IgG,ANA, dsDNA, ESR and CRP) of patients with lupus nephritis were detected, the correlation between sCysC and lupus activity, nephritis activity, dynamic changes in the treatment process were analyzed and compared with the traditional renal function index. Results: ①sCysC was significantly correlated with uTP, sAlb, SLEDAI and CRP, and the correlation was better than sCr and BUN. ②In the process of treatment, the correlation between sCysC and UTP, sAlb is better than that of sCr and BUN. ③The level of sCysC improved significantly with the treatment of hormone and immunosuppressant, which was found in BUN but not in Scr, while the level of sCysC improved significantly at the end of treatment of hormone and CTX, which was also found in the Scr but not in the BUN. ④eGFR based on combination of sCysC and sCr before treatment showed strongest correlation with other indicators, and the eGFR based on sCysC during treatment showed stronger correlation with other indicators. ⑤ Before treatment, 60.6% of the patients with normal sCr had a rise in serum sCysC, while 69.6% of the patients with normal sCr had a rise in sCysC, suggesting that sCysC could respond to the decline of renal function earlier than sCr. Conclusion: sCysC has better sensitivity in early renal damage, process of treatment and monitoring of therapeutic effect than sCr and BUN. eGFR based on sCysC or combination of sCysC and sCr calculation presented a better correlation with renal and systemic disease activities. sCysC can be used not only as a new marker of renal function, but also as a marker of inflammatory response in LN. |
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