|本期目录/Table of Contents|

[1]郝坤艳,杨玄子,何　锐,等.肝衰竭患者肾功能评估策略的优化分析[J].传染病信息,2019,04:203-207214.
　HAO Kun-yan,YANG Xuan-zi,HE Rui,et al.Analysis of optimal strategies for assessment of renal function in patients with liver failure[J].Infectious Disease Information,2019,04:203-207214.
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肝衰竭患者肾功能评估策略的优化分析(PDF)

《传染病信息》[ISSN:1007-8134/CN:11-3886/R]

期数:
2019年04期
页码:
203-207214
栏目:
论 著
出版日期:
2019-09-12

文章信息/Info

Title:
Analysis of optimal strategies for assessment of renal function in patients with liver failure
文章编号:
　　　1007-8134(2019)03-0203-06
作者:
郝坤艳; 杨玄子; 何　锐; 王寿明; 于乐成
210002南京，东部战区总医院，南京中医药大学附属八一医院，全军肝病中心（郝坤艳、杨玄子、王寿明、于乐成）；243031，马鞍山市第四人民医院肝病科（何锐）前两位作者对本文有同等贡献，均为第一作者
Author(s):
HAO Kun-yan;  YANG Xuan-zi;  HE Rui;  WANG Shou-ming;  YU Yue-cheng*
Liver Disease Center, General Hospital of Eastern Theater Command, Bayi Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 210002, China HAO Kun-yan and YANG Xuan-zi are the first authors who contributed equally to the article
关键词:
肝衰竭; 肾功能不全; 血清肌酐; 血清胱抑素; 估算肾小球滤过率; 优选
Keywords:
liver failure;  renal dysfunction;  serum creatinine;  serum cystain C;  evaluated glomerular filtration rate;  optimization
分类号:
R692；R575.3　　　　
DOI:
10.3969/j.issn.1007-8134.2019.03.003
文献标识码:
A
摘要:
目的　通过比较急性 /亚急性肝衰竭和慢加急性 /亚急性肝衰竭患者血清肌酐（ serum creatinine, Scr）、胱抑素 C（cystatin C, Cyc）及基于多种公式计算的估算肾小球滤过率（estimated glomerular .ltration rate, eGFR），优化筛选适合此类患者的肾功能评估指标。方法　回顾性分析 2011年 1月—2018年 5月符合急性 /亚急性肝衰竭（Ⅰ组）或慢加急性 /亚急性肝衰竭（Ⅱ组，又分Ⅱ A、Ⅱ B、Ⅱ C组）诊断标准的 210例肝衰竭患者的临床资料，以 213例健康体检者为对照组，比较各组 Scr、Cyc及 9种 eGFR计算公式在肝衰竭患者及对照组的组间和组内差异。结果　Ⅱ组 Scr和 Cyc水平显著高于对照组（ P均＜ 0.05）；I组 Cyc水平显著高于对照组（ P＜ 0.05），而 2组间 Scr水平比较，差异无统计学意义（ P＞ 0.05）。I、II组内 eGFR4、eGFR5、eGFR10及 eGFR7的异常率最低值分别为 100%、80.00%、96.44%及 60.00%，对照组内的异常率最低值分别为 100%、25.82%、70.89%及 10.33%。与 eGFR1和 eGFR2相比， eGFR3的假正常率最高，最高达 48.81%。血清 Cyc及 Scr均正常时，eGFR6假降低率较其他 eGFR均高，最高达 65.24%。结论　对于肝衰竭患者的肾功能评估，血清 Cyc较 Scr更为可靠。各种 eGFR公式中，以基于 Scr联合 Cyc的公式 eGFR11和基于 Scr的 eGFR2及 eGFR1较为合适，尤其是 eGFR11。　　
Abstract:
Objective　To optimize the rational indicators for the assessment of renal dysfunction in patients with acute/sub-acute liver failure (ALF/SALF) or acute/sub-acute on chronic liver failure (AOCLF/SAOCLF) by comparing serum creatinine (Scr), cystatin C (Cyc) and formula-based estimated glomerular filtration rates (eGFR). Methods　Two hundred and ten patients with liver failure hospitalizedbetween January 2011 and May 2018 who met the diagnosis criteria of ALF/SALF and AOCLF/SAOCLF were divided into group I(ALF/SALF) and group II (AOCLF/SAOCLF, including IIA, IIB and IIC), while 213 healthy examinee were selected as control group. The intergroup and intragroup difference of serum levels of Scr and Cyc, and 9 eGFR formula were compared. Results　Scr and Cyc levels were significantly higher in group II than those in control group (P＜ 0.05). Cyc levels were significantly higher in group I than that in control group (P＜ 0.05), while Scr levels had no statistical significance between 2 groups. The lowest abnormality rates of eGFR4, eGFR5,eGFR10 and eGFR7 were 100%, 80.00%, 96.44% and 60.00% in group I and II, and 100%, 25.82%, 70.89% and 10.33% in control group, respectively. Compared to eGFR1 and eGFR2, eGFR3 had the highest false negative rate which reached 48.81%. When both Cyc and Scr levels were normal, eGFR6 had a higher false negative rate than other eGFRs, which reached 65.24%. Conclusions　For assessment of renal dysfunction in patients with liver failure, serum Cyc is more reliable than Scr. Among various eGFR formula, formula eGFR11 based on the levels of Scr and Cyc, formula eGFR2 and eGFR1 based on the levels of Scr are the optimal formula, especially formula eGFR11. 　　　　

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备注/Memo

备注/Memo:
[基金项目]　原南京军区十一五医药科技重点项目（09Z011）
[作者单位]　210002南京，东部战区总医院，南京中医药大学附属八一医院，全军肝病中心（郝坤艳、杨玄子、王寿明、于乐成）；243031，马鞍山市第四人民医院肝病科（何锐）前两位作者对本文有同等贡献，均为第一作者
[通信作者]　于乐成，E-mail: gslsycy@163.com
更新日期/Last Update: 2019-07-12