胱抑素-C监测含铂方案化疗对肾功能影响的临床观察

    Cystatin C in monitoring renal impairment in patients receiving chemotherapy with platinum containing regimens

    • 摘要: 目的: 探讨胱抑素-C (Cys-C)在监测含铂方案化疗对肾功能损伤中的作用价值。方法: 采集接受含铂药物方案化疗患者化疗前和化疗结束后第7天静脉血,检测血Cys-C和肌酐(Cr),并观察其与肌酐清除率(CCr)之间的关系。结果: 37例患者共接受74周期含铂方案化疗。血Cr和Cys-C之间存在直线相关关系(r=0.398,P < 0.01),Cys-C和CCr之间存在直线相关关系(r=0.412,P < 0.01),Cys-C与CCr的相关性不比Cr更好(r=0.412 vs r=0.567,P > 0.05)。患者化疗后血Cys-C值高于化疗前(P < 0.01),其中16例患者接受含顺铂方案化疗,共32个周期,化疗前后Cys-C值较化疗前增加(P < 0.01);21例患者接受含草酸铂或奈达铂方案化疗,共42个周期,化疗后血Cys-C值亦较化疗前增加(P < 0.01)。2组患者化疗后血Cr水平变化差异无统计学意义(P > 0.05)。接受顺铂方案化疗后的患者血Cys-C异常发生率显著高于接受其他铂类药物化疗的患者(P < 0.01),所有患者中化疗后发生Cr值异常仅1例。结论: 含铂方案化疗时,血Cys-C作为监测肾功能变化的指标,其敏感性较好,但临床应用尚存在一定问题,不能替代Cr。

       

      Abstract: Objective: To study the value of cystatin C in monitoring the renal function of patients receiving chemotherapy with platinum containing regimens. Methods: The blood samples of the patients receiving chemotherapy with platinum containing regimens were collected before and 7 days after the therapy to detect the cystatin C and creatinine,and the correlation between them was also observed. Results: Thirty-seven patients received 74 cycles of chemotherapy in all. The correlation between serum Cr and Cystatin C was confirmed (r=0.398,P < 0.01);Cystatin C was correlated with creatinine significantly (r=0.412,P < 0.01),and its correlation with CCr was no better than creatinine (r=0.412 vs r=0.567,P > 0.05);the serum Cystatin C level of the patients was higher after chemotherapy than before (P < 0.01). Sixteen of the patients received chemotherapy with cisplatin for 32 cycles,and their serum Cystatin C levels increased (P < 0.01);21 patients received chemotherapy with non-cisplatin for 42 cycles,and the results were the same (P < 0.01). The serum creatinine concentrations were not significantly different before and after chemotherapy in the two groups (P > 0.05). The abnormal rate of Cystatin C in patients receiving chemotherapy with cisplatin was higher than that with non-cisplatin chemotherapy (P < 0.01). Creatinine was detected abnormal only in one case. Conclusions: Cystatin C presents a much more sensitive clinical marker than creatinine for early assessment of GFR damage caused by chemotherapy with platinum containing regimens,but as there are some difficulties in clinical application,it could not act as a substitute for creatinine.

       

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