分析血清胱抑素C（CysC）联合尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）在肝硬化患者并发症急性肾功能损伤（AKI）中的诊断价值。

对湖北省天门市第一人民医院2014年4月至2017年4月期间收治的120例肝硬化并发AKI患者的临床资料进行回顾性分析，根据患者AKI分期标准将患者分成AKI 1期组、AKI 2期组以及AKI 3期组，每组40例，同时另选取同时段进行健康体检的健康者40名作为对照组。根据血清CysC与尿NGAL水平表达情况，以表达水平高于基础值50%为基线，设为高CysC组、高NGAL组以及高CysC＋NGAL组。采用单因素方差检验分析比较AKI 1期组、AKI 2期组、AKI 3期组与对照组之间血清CysC、尿NGAL、血清肌酐（SCr）、APACHE Ⅱ评分的差异，比较高CysC组、高NGAL组以及高CysC＋NGAL组APACHE Ⅱ评分的差异，组间差异的两两比较采用SNK-q检验；采用两独立样本t检验比较存活组与死亡组血清CysC、尿NGAL及APACHE Ⅱ评分；采用χ²检验比较各组的存活情况，组间的两两比较采用χ²分割检验；血清CysC、尿NGAL水平与APACHEⅡ评分的相关性采用Pearson积差相关分析。

对照组、AKI 1期组、AKI 2期组与AKI 3期组中血清CysC、尿NGAL与SCr表达水平随着AKI病情分期的增加而升高，APACHE Ⅱ评分亦随着病情的加重而增加；血清CysC方面，AKI 1期组、AKI 2期组、AKI 3期组与对照组比较，差异具有统计学意义（q=4.807，P=0.036；q=15.449，P<0.001；q=23.942，P<0.001）；AKI 2期组、AKI 3期组与AKI 1期组比较差异具有统计学意义（q=10.641，P<0.001；q=19.136，P<0.001）；AKI 3期组与AKI 2期组比较，差异具有统计学意义（q=8.495，P=0.01）；尿NGAL方面，AKI 1期组、AKI 2期组、AKI 3期组与对照组比较，差异具有统计学意义（q=6.109，P=0.012；q=10.997，P<0.001；q=19.375，P<0.001）；AKI 2期组、AKI 3期组与AKI 1期组比较差异具有统计学意义（q=4.887，P=0.031；q=13.266，P<0.001）；AKI 3期组与AKI 2期组比较，差异具有统计学意义（q=8.378，P=0.004）；SCr方面，AKI 1期组、AKI 2期组、AKI 3期组与对照组比较，差异具有统计学意义（q=8.461，P=0.003；q=21.198，P<0.001；q=42.995，P<0.001）；AKI 2期组、AKI 3期组与AKI 1期组比较差异具有统计学意义（q=12.737，P<0.001；q=34.534，P<0.001）；AKI 3期组与AKI 2期组比较，差异具有统计学意义（q=21.797，P<0.001）；APACHE Ⅱ评分方面，AKI 2期组、AKI 3期与AKI 1期组比较差异具有统计学意义（q=10.907，P<0.001；q=21.643，P<0.001）；AKI 3期组与AKI 2期组比较，差异具有统计学意义（q=10.737，P<0.001）；病死率方面，AKI 2期组、AKI 3期组与AKI 1期组比较，差异具有统计学意义（χ²=4.766，P=0.029；χ²=13.272，P<0.001）；AKI 3期组与AKI 2期组比较，差异具有统计学意义（χ²=5.208，P=0.022）。高CysC组、高NGAL组与高NGAL+CysC组APACHE Ⅱ评分以及死亡率逐渐升高，APACHE Ⅱ评分方面，高CysC组、高NGAL组与高NGAL+CysC组比较，差异具有统计学意义（q=17.440，P<0.001；q=16.206，P<0.001）；高CysC组与高NGAL组比较，差异无统计学意义（q=1.234，P=0.452）；病死率方面，高CysC组、高NGAL组与高NGAL＋CysC组比较，差异具有统计学意义（χ²=8.010，P=0.005；χ²=5.148，P=0.023），高CysC组与高NGAL组比较，差异无统计学意义（χ²=1.173，P=0.279）。死亡组患者血清CysC与尿NGAL表达水平高于存活组，差异具有统计学意义（t=13.687，12.246，P均<0.001）。APACHE Ⅱ评分结果死亡组高于存活组，差异具有统计学意义（t=18.872，P<0.001）；血清CysC及尿NGAL水平与APACHE Ⅱ评分成线性相关性（r=0.868，P=0.003；r=0.721，P=0.008）。

尿NGAL与血清CysC是预测AKI发病的早期指标，两者联合检测能进一步提高对AKI的早期诊断，可作为临床上诊断AKI患者病情与预后的指标。

To assess the value of serum CysC combined with urinary NGAL in the diagnosis of acute kidney injury in patients with liver cirrhosis.

The clinical data of 120 cases of liver cirrhosis complicated with acute renal injury treated at the First People's Hospital of Tianmen, Hubei, China from April 2014 to April 2017 were retrospectively analyzed. According to the AKI criteria, the patients were divided into an AKI 1 group, AKI 2 group, and AKI 3 group, with 40 cases in each group. Forty cases who received normal health examination at the same hospital during the same period were selected as a control group. Urine NGAL was detected by solid phase sandwich enzyme-linked immunosorbent assay (ELISA), serum CysC was detected by ELISA, and creatinine (SCr) was detected by serum oxidase method. One-way analysis of variance was used to compare the difference of urine NGAL and serum CysC expression among the four groups, and the correlation between serum CysC, the level of urine NGAL, and the APACHE Ⅱ score was assessed by Pearson correlation analysis.

Serum CysC, urinary NGAL and Scr levels, and APACHEⅡ score increased with disease severity. Serum CysC levels in the three AKI groups were significantly different from that in the control group (q=4.807, P=0.036; q=15.449, P<0.001; q=23.942, P<0.001); a significant difference was also observed between the AKI 2/3 groups and AKI 1 group (q=10.641, P<0.001; q=19.136, P<0.001), as well as between the AKI 3 and AKI 2 groups (q=8.495, P=0.01). Urinary NGAL levels in the three AKI groups were significantly different from that in the control group (q=6.109, P=0.012; q=10.997, P<0.001; q=19.375, P<0.001); a significant difference was also observed between the AKI 2/3 groups and AKI 1 group (q=4.887, P=0.031; q=13.266, P<0.001), as well as between the AKI 3 and AKI 2 groups (q=8.378, P=0.004). Scr levels in the three AKI groups were significantly different from that in the control group (q=8.461, P=0.003; q=21.198, P<0.001; q=42.995, P<0.001); a significant difference was also observed between the AKI 2/3 groups and AKI 1 group (q=12.737, P<0.001; q=34.534, P<0.001), as well as between the AKI 3 group and AKI 2 group (q=21.797, P<0.001). APACHE Ⅱ score differed significantly between the AKI 2/3 groups and AKI 1 group (q=10.907, P<0.001; q=21.643, P<0.001), as well as between the AKI 3 group and AKI 2 group (q=10.737, P<0.001). The mortality rates differed significantly between the AKI 2/3 groups and the AKI 1 group (χ²=4.766, P=0.029, χ²=13.272, P<0.001), as well as between the AKI 2 and AKI 3 groups (χ²=5.208, P=0.022). APACHEⅡ score increased with the aggravation of the disease. APACHE Ⅱ score in the high CysC + high NGAL group was significantly higher than that in the high CysC alone group or high NGAL alone group (q=17.440, P<0.001; q=16.206, P<0.001). APACHE Ⅱ score was not significantly different between the high CysC alone group and high NGAL alone group (q=1.234, P=0.452). The mortality rate of patients with high CysC and high NGAL was significantly higher than that of patients with high CysC alone (χ²=8.010, P=0.005) or high NGAL alone (χ²=5.148, P=0.023). The mortality rate was statistically higher in the high CysC alone group than in the high NGAL alone group (χ²=1.173, P=0.279). Serum CysC and urinary NGAL in the death group were significantly higher than those in the survival group. APACHE score in the death group was signficantly higher than that of the survival group (t=18.872, P<0.001). Serum CysC and urinary NGAL levels were linearly correlated with APACHE score (r=0.868, P=0.003; r=0.721, P=0.008).

Urinary NGAL and serum CysC are the early indicators for predicting the onset of AKI, and combined detection of them can further improve the early diagnosis of AKI. Urinary NGAL and serum CysC can be used as indicators for evaluating the clinical condition and prognosis of liver cirrhosis patients with AKI.