Clinical Study On Serum Cystatin C And Acute Stroke&Changes In Renal Function

Objective:In order to judge severity of state of the acute stroke and provide quantitativeinformation to changes in renal function in acute stroke patents，we explore therelationship between serum cystatin C and acute stroke from from the perspectives ofinfarction area、blood loss and National Institutes of Health Neurological deficitscores(NIHSS) of acute stroke，and in order to judge relevant impacts of mannitolused in different doses by patients with acute stroke on renal functions in differenttime points，we test the content of serum cystatin C which is of great significant forthe selection of therapeutic regimen.Methods:According to diagnostic criteria revised on the4thNational Conference ofCerebrovascular Diseases in1995, patients within five days after attack of acutestroke in the Department of Neurology in the First Affiliated Hospital of NanchangUniversity from May,2013to February,2014are selected as the case group, in which121are in the cerebral ischemic stroke (cerebral infarction) group, and82are in thehemorrhagic stroke (cerebral hemorrhage) group. Besides,80healthy physicalexaminees with similar age are selected as the control group. After that, the followingmaterials of both the case group and the control group are collected: clinical data,laboratory examination indicators, skull MRI/CT,12-lead ECG, NIHSS scores, dosesof mannitol used, etc. Then, the case group is divided into different groups for acomparison with the control group, testing the Cys C level of subjects with theimmunoturbidimetry, monitoring dynamic changes in serum Cys C of patients in theperiod of using mannitol, and analyzing the relations between mannitol and renalfunctions of patients with acute stroke.Result:①the concentrations of serum Cys C in acute stroke patients is higher thanhealthy persons for comparion group serum Cys C concentrations.②according to the pearson correlation analysis, the level of serum Cys C is positively correlated with the age,homocysteine (Hcy), Creatinine (Cr), Ureanitrogen(BUN), uric acid (UA)of patients with cerebral infarction;the level of serumCys C is positively correlated with Hcy,Cr,BUN,UA of patients with cerebralhemorrhage.③large、middlel cerebral infarction area group Cys C concentrations arehigher than healthy persons for comparion group Cys C concentrations,but smallcerebral infarction group Cys C concentrations have no significant different；large、middle、small cerebral blood loss, group Cys C concentrations are higher than healthypersons for comparion group Cys C concentrations; With increasing infarction areaand blood loss, the level of serum Cys C gradually rises, with statistical significancein difference.④NIHSS scores are not correlated with the level of serum Cys C of patientswith acute stroke.⑤in the fifth day of mannitol intravenous drip in500ml per day (4times a day),the level of serum Cys C is higher than that before the treatment. In the tenth day, thelevel of serum Cys C, Cr and BUN are higher than that before the treatment, withstatistical significance. In the tenth day of mannitol intravenous drip in375ml per day(3times a day), the level of serum Cys C and Cr are higher than that before thetreatment, with statistical significance. There is no statistical significance in the levelof serum Cys C, Cr and BUN between mannitol intravenous drip in500ml per dayand that in375ml per day before the treatment, in the fifth day of the treatment and intenth day of the treatment.Conclusions:①elevated levels of serum Cys C is important for the diagnosis of acute strokein occurrence and development,and the higher the content, the greater the risk.②the level of serum Cys C may be affected by Hcy、Cr、UAand BUN，and haslinear relationship with them；the level of serum Cys C increases with increasinginfarction area and blood loss, and it can be served as an indicator for judging severityof acute stroke and changes in renal functions.but the level of serum Cys C have nosignificant correlation with NIHSS.③with respect to monitoring relevant impacts of mannitol on renal functions, serum Cys C is superior to Cr and BUN. Due to long-term use of mannitol, itsimpacts on renal functions increase. However, it still requires further demonstrationfor dosage (times) probably having relatively less impacts on renal functions.