CysC-鑳辨姂绱燙娴嬪畾璇曞墏鐩?鑳朵钩鍏嶇柅姣旀祳娉?
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妫€娴嬪師鐞咟/h3>
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- 琛€CysC娴撳害涓庤偩鍔熻兘鎹熷绋嬪害楂樺害鐩稿叧锛岃兘鍑嗙‘鍙嶆槧GFR鍙樺寲锛岃CysC鍗囬珮鎻愮ず鑲惧皬鐞冩护杩囧姛鑳藉彈鎹熴€傝CysC鍙敤浜庣硸灏跨梾鎬ц偩鐥呰偩鑴忔护杩囧姛鑳芥棭鏈熸崯浼ょ殑璇勪环銆侀珮琛€鍘嬭偩鍔熻兘鎹熷鏃╂湡璇婃柇銆佽偩绉绘鎮ｈ€呰偩鍔熻兘鐨勬仮澶嶆儏鍐佃瘎浼般€佹姉鐢熺礌瀵艰嚧鑲惧皬鐞冩护杩囧姛鑳藉井灏忔崯浼よ瘖鏂互鍙婂叾浠栬偩灏忕悆鏃╂湡鎹熶激鐨勮瘖鏂強棰勫悗鍒ゆ柇銆佽娑查€忔瀽鎮ｈ€呰偩鍔熻兘鏀瑰彉鐩戞祴銆佽€佸勾浜鸿偩鍔熻兘璇勪环銆佸効绉戣偩鐥呯殑璇婃柇銆佽偪鐦ゅ寲鐤椾腑鑲惧姛鑳界殑鐩戞祴绛堻span style="color:hsl(212,80%,42%);">[1,2]銆侟/li>
- CysC鏄綆鍒嗗瓙閲忚泲鐧借川涓笌GFR鏈€鐩稿叧鐨勫唴婧愭€ф爣蹇楃墿锛岃CysC娴撳害涓嶨FR鍛堣壇濂界殑绾挎€у叧绯伙紝鍏剁嚎鎬у叧绯绘樉钁椾紭浜庤鑲岄厫锛岃兘鏇寸簿纭弽鏄燝FR,鐗瑰埆鏄湪鑲惧姛鑳戒粎杞诲害鍑忛€€鏃讹紝琛€CysC鐨勬晱鎰熸€ч珮浜庤鑲岄厫[1]銆侟/li>
- CysC涓庢€ユ€ц偩鎹熶激(AKI)銆傚椤圭爺绌剁粨鏄剧ず锛屽湪瀛樺湪鍗遍櫓鍥犵礌鐨凙KI鍗遍噸鎮ｈ€呬腑锛岃CysC姘村钩鍗囬珮涓嶢KI鐨勫彂鐢熼闄╂鐩稿叧锛屽苟涓旇CysC姘村钩鍗囬珮鏃╀簬琛€鑲岄厫1~2d銆備笌琛€鑲岄厫鐩告瘮锛孋ysC鍦ㄦ娴婫FR鍑忓皬鍙樺寲鏂归潰鏇村叿鏈変紭鍔军span style="color:hsl(212,80%,42%);">[3]銆傘€婁腑鍥芥€ユ€ц偩鎹熶激涓村簥瀹炶返鎸囧崡銆婞span style="color:hsl(212,80%,42%);">[4]寤鸿瀵笰KI楂橀闄╂偅鑰呭畾鏈熺洃娴嬭鑲岄厫銆佽娓匔ysC銆佸翱N-涔欓叞-β-钁¤悇绯栬嫹閰?NAG)鍜屽翱閲忥紝浠ユ棭鏈熻瘖鏂瑼KI;寤鸿鑱斿悎鐢熺墿鏍囧織鐗?濡傝娓匔ysC銆佸翱NGAL绛?瀵规棭鏈熷効绔KI杩涜绉戝璇勪及銆侟/li>
- CysC涓庢參鎬ц偩鑴忕梾銆侰ysC鍙湁鏁堝弽鏄犳満浣撹偩灏忕悆婊よ繃鐜囷紝鍙负涓村簥閴村埆绯栧翱鐥呰偩鐥呯梾渚嬫彁渚涢噸瑕佸弬鐓?span style="color:hsl(212,80%,42%);">[5]銆傝娓匔ysC鍙綔涓轰复搴婅瘖鏂珮琛€鍘嬭偩鐥呮棭鏈熺殑閲嶈鎸囨爣锛屼笖CysC姘村钩涓庨珮琛€鍘嬭偩鐥呮偅鑰呯殑鐥呮儏涓ラ噸绋嬪害鍛堟鐩稿叧锛屽彲涓洪珮琛€鍘嬭偩鐥呮偅鑰呯殑鍒嗘湡璇婃柇鍙婂悗缁不鐤楁彁渚涙湁鍔涘弬鐓?span style="color:hsl(212,80%,42%);">[6]銆傘€婃參鎬ц偩鑴忕梾鏃╂湡绛涙煡,璇婃柇鍙婇槻娌绘寚鍗?2022骞寸増)銆婞span style="color:hsl(212,80%,42%);">[8]鎸囧嚭锛屼笌琛€娓呰倢閰?Scr)鐩告瘮锛岃CysC姘村钩鍙楄偩澶栧洜绱犵殑褰卞搷鐩稿杈冨皯锛屽熀浜嶴cr鍜孋ysC鐨勮仈鍚堝叕寮?CKD-EPIcr-cyst)杈冨崟绾熀浜嶴cr鐨勫叕寮 (CKD-EPIcr)浼扮畻eGFR鏇村姞鍑嗙‘锛屽挨鍏跺浜庨珮榫勩€佽惀鍏讳笉鑹€佽倢鑲夊惈閲忎綆鍙婅倽鍔熻兘闅滅鑰呫€傚浗鍐呭閽堝鑰佸勾浜虹殑鏁伴」鐮旂┒涔熷彂鐜癈KD-EPIcr-cyst鑱斿悎鍏紡鐨勫噯纭€т紭浜庡叾浠杄GFR浼版祴鍏紡[9]銆侰ysC浣滀负鑲惧姛鑳借瘎浠锋寚鏍囦笌鑲惧皬鐞冩护杩囩巼鏈夎緝濂界殑鐩稿叧鎬э紝鍙綔涓哄効绔KD鏃╂湡绛涙煡鎸囨爣[10]銆傚湪2012骞碖DIGO鎸囧崡涓寚鍑猴紝琛€娓呰倢閰愭按骞虫垨浣跨敤鍎跨涓撶敤鍏紡浼扮畻GFR瀵笴KD鎮ｅ効鑲惧姛鑳借繘琛岃瘎浠锋瑺缂哄噯纭€э紝鏄撳彈鑲惧鍥犵礌鐨勫奖鍝嶏紝鎺ㄨ崘灏嗚娓呰儽鎶戠礌C妫€娴嬪強鍏禛FR浼扮畻浣滀负璇勪环CKD鎮ｅ効鑲惧姛鑳界殑棰濆鎸囨爣[10]銆侟/li>
- CysC鍙敤浜庤偩绉绘鎮ｈ€呰偩鍔熻兘璇勪环銆傜敱浜庤Scr鍗囬珮缂撴參锛屼笉鑳藉強鏃躲€佸噯纭弽鏄犵Щ妞嶈偩涔嬪姛鑳见鑰孋ysC鍦ㄨ偩绉绘鎮ｈ€呯殑鐩稿叧鐮旂┒涓樉绀哄嚭浜嗗叾鐢ㄤ簬鐩戞祴鏃╂湡鑲惧姛鑳界殑鑹ソ搴旂敤鍓嶆櫙銆傝偩绉绘鎴愬姛鏃讹紝琛€娓匔ysC涓嬮檷鐨勯€熷害鍜屽箙搴﹀潎澶т簬鑲岄厫娓呴櫎鐜嘂鍙戠敓绉绘鎺掓枼鍙嶅簲鏃讹紝琛€娓匔ysC澧為珮鏄庢樉鏃╀簬鑲岄厫娓呴櫎鐜嘃span style="color:hsl(212,80%,42%);">[2]銆侟/li>
- CysC鍙敤浜庤倽绉绘鍙楄€呰偩鍔熻兘璇勪及銆傚浜庡悎骞禖KD鐨勮倽绉绘鍙楄€咃紝eGFR鍙兘楂樹及鑲濈Щ妞嶅彈鑰呭疄闄匞FR锛岃€屼綆浼癈KD瀵瑰叾閫犳垚鐨勬浜￠闄┿€傜爺绌舵樉绀猴細CysC鍗曠函鐢盙FR鍐冲畾锛屼笉鍙楁€у埆銆佸勾榫勩€侀ギ椋熴€佺値鐥囥€佹劅鏌撱€佹伓鎬ц偪鐦ゃ€佽倽鑴忕柧鐥呯瓑鐥呯悊鐢熺悊鍥犵礌褰卞搷锛屽浜庣瓑寰呰倽绉绘鍙楄€咃紝灏ゅ叾鏄倽纭寲鎮ｈ€咃紝CysC鏄弽鏄犲拰璇勪及鐪熷疄GFR鐨勬洿鐞嗘兂鎸囨爣銆侰ysC涔熷彲浣滀负鑲濈Щ妞嶆湳鍚庢棭鏈熷彂鐜癈KD鐨勬晱鎰熸寚鏍囥€傛牴鎹瓹ysC鍜孋r-CysC鍏紡璁＄畻鐨別GFR (eGFRcys鍜宔GFRcreat-cys)锛岃嫢eGFRcys鍜宔GFRcreat-cys<60 ml/(min銉?.73m2)锛屽垯CKD璇婃柇纭珛銆傛潵鑷腑鍥界殑鑲濈Щ妞嶅彈鑰呮暟鎹樉绀猴細鍩轰簬CysC璁＄畻鐨別GFR涓庣湡瀹炵殑GFR闈炲父鎺ヨ繎[11]銆侟/li>
- 灏緾ysC鍙綔涓鸿偩灏忕鍔熻兘涓嶅叏鎸囨爣銆侰ysC缁忚偩灏忕悆婊よ繃鍚庯紝瑕佽杩戞洸灏忕涓婄毊鍒嗚В浠ｈ阿;灏緾ysC澧為珮鍙弽鏄犺繎鏇插皬绠′笂鐨垎瑙ｄ唬璋ysC鐨勫姛鑳戒笅闄嶏紝鏄繎鏇插皬绠′笂鐨彈鎹熺殑琛ㄧ幇[2]銆侟/li>
- 琛€娓匔ysC浣滀负涓€绉嶆柊鍨嬪績琛€绠＄柧鏍囧織鐗╋紝瓒婃潵瓒婂彈鍒板叧娉ㄣ€侰ysC涓庡啝蹇冪梾鍙戠梾鏈哄埗瀵嗗垏鐩稿叧锛孋ysC鍙€氳繃鍙備笌鐐庣棁鍙嶅簲銆佽绠″鍩鸿川鐨勪骇鐢熷強闄嶈В銆佽绠″鐨勬崯浼ょ瓑鐥呯悊鐢熺悊杩囩▼璇卞鍔ㄨ剦绮ユ牱纭寲褰㈡垚[12]銆傚啝蹇冪梾鎮ｈ€呰娓匔ysC姘村钩涓庡啝鐘跺姩鑴夌梾鍙樹弗閲嶇▼搴﹀憟姝ｇ浉鍏颤span style="color:hsl(212,80%,42%);">[13,14]銆侰ysC涓嶄粎涓庢€ユ€у績鑲屾姝?AMI)鍙戠敓鏈夌潃瀵嗗垏鍏崇郴锛屼笖涓嶢MI鎮ｈ€呴鍚庢湁鍏筹紝CysC姘村钩瓒婇珮锛孉MI鎮ｈ€呴鍚庡垯瓒婂樊[15]銆侻atsushita绛堻span style="color:hsl(212,80%,42%);">[16]璇佹槑CysC鏄績鍔涜“绔殑鐙珛鍗遍櫓鍥犵礌锛屽苟涓旈殢鐫€鍏舵祿搴︾殑澧炲姞鍙戠敓蹇冨姏琛扮鐨勯闄╀篃鏄€愭澧炲姞鐨勩€傚湪鑰佸勾浜轰腑锛孋ysC鐩稿浜庤倢閰愭槸棰勬祴姝讳骸椋庨櫓鏇村己鐨勭敓鐗╁鎸囨爣锛孋ysC鍜孨T-pro BNP鐩哥粨鍚堝蹇冭绠＄柧鐥呬笉鑹簨浠舵湁鏇村己鐨勯娴嬩綔鐢ㄣ€傛湁鐮旂┒鍙戠幇锛岃CysC瀵规€ユ€у績鍔涜“绔偅鑰呴鍚庣殑棰勬祴浠峰€奸珮浜庤剳閽犺偨 (BNP)鍜岃倢閽欒泲鐧絋 (TnT) 绛夋寚鏍囷紝鏄弽鏄犳€ユ€у績鍔涜“绔鍚庣殑鏁忔劅鎸囨爣;琛€CysC瓒婇珮锛屾浜＄巼涔熻秺楂楛span style="color:hsl(212,80%,42%);">[2]銆侟/li>
閫傜敤绉戝
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鍎跨 |
鐢ㄤ簬鍎跨鑲剧梾鐨勮瘖鏂拰GFR鐨勮瘎浼帮紱鎺ㄨ崘灏嗕骇鍓嶆鏌ュ彂鐜拌偩鑴忓彂鑲插紓甯哥殑鎮ｅ効绾冲叆 CKD 鏃╂湡绛涙煡鐨勯珮鍗辩兢浣擄紝瀹氭湡杩涜绛涙煡锛涘缓璁皢涓€绾т翰灞炴湁鑲捐剰鐤剧梾鐩稿叧鐥呭彶鐨勫効绔ョ撼鍏 CKD 鏃╂湡绛涙煡鐨勯珮鍗辩兢浣擄紝瀹氭湡杩涜绛涙煡锛涘缓璁皢鏈堿KI鐥呭彶鐨勫効绔ョ撼鍏KD鏃╂湡绛涙煡鐨勯珮鍗辩兢浣擄紝瀹氭湡杩涜绛涙煡 |
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绉绘绉慄/strong> |
CysC鍙敤浜庤倽绉绘鎴栬偩绉绘鎮ｈ€呰偩鍔熻兘鐨勮瘎浠峰強鐩戞祴 |
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鑲跨槫绉慄/strong> |
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蹇冭剰澶栫 |
鑳辨姂绱燙鍙敤浣滃啝鑴夋墜鏈悗鐩戞祴鑲炬崯浼ょ殑鏁忔劅鎸囨爣 |
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蹇冨唴绉慄/strong> |
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浣撴绉?浣撴涓績 |
鏅€氫汉缇ゅ挨鍏惰€佸勾浜猴紝杩涜CKD绛涙煡 |
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[1]灏逛竴鍏? 鍊煿鍗? 涓村簥鐢熺墿鍖栧妫€楠屾妧鏈痆M]. 绗?鐗? 鍖椾含: 浜烘皯鍗敓鍑虹増绀? 2015.
[2]灏氱孩, 鐜嬫瘬涓? 鐢冲瓙鐟? 鍏ㄥ浗涓村簥妫€楠屾搷浣滆绋媅M]. 绗?鐗? 鍖椾含: 浜烘皯鍗敓鍑虹増绀? 2015.
[3]鍞愭槉,钂嬩笢鍧?鎬ユ€ц偩鎹熶激鐨勭敓鐗╁鏍囧織鐗╄兘鍚﹀府鍔╂棭鏈熻瘖鏂?[J].涓崕閲嶇棁鍖诲鐢靛瓙鏉傚織(缃戠粶鐗?, 2017, 3(1):33-39.
[4]鍥藉鎱㈡€ц偩鐥呬复搴婂尰瀛︾爺绌朵腑蹇?涓浗鍖诲笀鍗忎細鑲捐剰鍐呯鍖诲笀鍒嗕細,涓浗鎬ユ€ц偩鎹熶激涓村簥瀹炶返鎸囧崡涓撳缁? 涓浗鎬ユ€ц偩鎹熶激涓村簥瀹炶返鎸囧崡[J]. 涓崕鍖诲鏉傚織,2023,103(42):3332-3366.
[5]璧典簹濡?鐜嬪悰,璧垫. 琛€娓?beta;2寰悆铔嬬櫧銆佽榛勯唶缁撳悎铔嬬櫧銆佽儽鎶戠礌C銆佷腑鎬х矑缁嗚優鏄庤兌閰剁浉鍏宠剛璐ㄨ繍杞借泲鐧藉強鍩鸿川閲戝睘铔嬬櫧閰?澶氭寚鏍囪仈鍚堟娴嬪湪绯栧翱鐥呰偩鐥呮偅鑰呬腑鐨勪环鍊糩J]. 瀹炵敤涓村簥鍖昏嵂鏉傚織,2018,22(13):20-23.
[6]鍠诲灇,寮犳槬鏁?榛勫姊?绛? 琛€娓呰儽鎶戠礌 C 鍜?beta;2寰悆铔嬬櫧鑱斿悎妫€娴嬪鎱㈡€ц偩鑴忕梾鏃╂湡鐨勮瘖鏂环鍊糩J]. 涓村簥鑲捐剰鐥呮潅蹇?2015(9):545-549.
[8]涓婃捣甯傝偩鍐呯涓村簥璐ㄩ噺鎺у埗涓績涓撳缁? 鎱㈡€ц偩鑴忕梾鏃╂湡绛涙煡銆佽瘖鏂強闃叉不鎸囧崡(2022骞寸増)[J]. 涓崕鑲捐剰鐥呮潅蹇?2022,38(5):453-464.
[9]涓崕鍖诲浼氳€佸勾鍖诲鍒嗕細鑲剧梾瀛︾粍,鍥藉鑰佸勾鐤剧梾涓村簥鍖诲鐮旂┒涓績. 鑰佸勾浜烘參鎬ц偩鑴忕梾璇婃不涓浗涓撳鍏辫瘑(2018)[J]. 涓崕鑰佸勾鍖诲鏉傚織,2018,37(7):725-731.
[10]涓崕鍖诲浼氬効绉戝鍒嗕細鑲捐剰瀛︾粍,涓崕鍎跨鏉傚織缂栬緫濮斿憳浼? 涓浗鍎跨鎱㈡€ц偩鑴忕梾鏃╂湡绛涙煡涓村簥瀹炶返鎸囧崡(2021鐗?[J]. 涓崕鍎跨鏉傚織,2022,60(9):858-868.
[11]涓浗鍖诲笀鍗忎細鍣ㄥ畼绉绘鍖诲笀鍒嗕細,涓崕鍖诲浼氬櫒瀹樼Щ妞嶅鍒嗕細鑲濈Щ妞嶅缁? 涓浗鑲濈Щ妞嶅彈鑰呰偩鎹熶激绠＄悊涓撳鍏辫瘑(2017鐗?[J]. 涓崕绉绘鏉傚織(鐢靛瓙鐗?,2017,11(3):130-137.
[12]鐜嬪缓,鍒樻檽绾?闄堣嫢璇?绛? 琛€娓呰儽鎶戠礌C涓庡父瑙佸績琛€绠＄柧鐥呯殑鍏崇郴[J]. 涓浗浠嬪叆蹇冭剰鐥呭鏉傚織,2020,28(10):585-588.
[13]Zhang J, Wu X, Gao P, Yan P. Correlations of serum cystatin C and glomerular filtration rate with vascular lesions and severity in acute coronary syndrome. BMC Cardiovasc Disord. 2017 Jan 31;17(1):47.
[14]Okyay K, Y谋ld谋r谋r A, 脟i莽ek M, Ayd谋nalp A, M眉derriso臒lu H. Serum cystatin C and neutrophil gelatinase-associated lipocalin in predicting the severity of coronary artery disease in diabetic patients. Anatol J Cardiol. 2016 Oct;16(10):756-761.
[15]Correa S, Morrow DA, Braunwald E, Davies RY, Goodrich EL, Murphy SA, Cannon CP, O'Donoghue ML. Cystatin C for Risk Stratification in Patients After an Acute Coronary Syndrome. J Am Heart Assoc. 2018 Oct 16;7(20):e009077.
[16] Matsushita K, Sang Y, Ballew SH, Astor BC, Hoogeveen RC, Solomon SD, Ballantyne CM, Woodward M, Coresh J. Cardiac and kidney markers for cardiovascular prediction in individuals with chronic kidney disease: the Atherosclerosis Risk in Communities study. Arterioscler Thromb Vasc Biol. 2014 Aug;34(8):1770-7.
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