Diagnostic Value Of Combined Detection Of Serum Cys-C And ?2-MG In Hepatorenal Syndrome And Clinical Significance

Objective:To explore the clinical features of patients with hepatorenal syndrome in the affiliated hospital of Yan'an University and study the efficacy of combined detection of Cys-C and ?2-MG in early diagnosis and differential diagnosis of hepatorenal syndrome.Method:1.Retrospective analysis of patients with liver cirrhosis confirmed by pathology,imaging and laboratory examination in the Yan'an University Affiliated Hospital from January 2013 to December 2018?2.All researchers completed blood routine,blood coagulation,and renal electrolytes when they were admitted to the hospital.Liver function was detected on an empty stomach in the morning after admission.After stable disease,abdominal B-ultrasound,upper abdomen enhanced CT+ portal venography,gastroscopy,etc.,to detect cirrhosis lesions,varicose veins.The cause,clinical manifestations and related complications of liver cirrhosis in patients were recorded.Patients were grouped according to clinical presentation,imaging findings,and laboratory findings.Divided into: HRS group(type I HRS,type II HRS),subclinical HRS group,ATN group,PRA group,Pure cirrhosis group.3.The results of the study was performed on Statistical analysis using Spass19.0 statistical software.Comparison of measurement data among multiple groups: Consistent with normal distribution expressed as mean ± standard deviation((?)±S),using One-way analysis of variance;Not conforming to normal distribution with median ± interquartile range(M±Q)indicates that the rank sum test is used.The chi-square test was used to compare the count data between groups.Multivariate analysis was performed using unconditional logistic regression model to screen out independent risk factors for HRS.Pearson correlation analysis was used to detect the correlation between Cys-C,?2-MG,Urea and Cr.The ROC curves of the subclinical HRS,HRS,PRA,and ATN subjects were drawn out,and the sensitivity of the combined detection of Cys-C and ?2MG in the AKI group was compared.P < 0.05 was considered statistically significant.4.The ROC curves of type I HRS group and type II HRS group were drawn to detect the diagnostic efficacy of joint detection of Cys-C and ?2-MG.Result:1.The clinical data of 2430 patients with liver cirrhosis were included in the study,including 1680 males(69.2%)and 750females(30.8%).Age range 22 to 77 years old,average age 58 years old.There were 1886 cases of hepatitis B liver cirrhosis,213 cases of hepatitis C liver cirrhosis,42 cases of alcoholic liver cirrhosis,152 cases of autoimmune liver cirrhosis,and 210 cases of liver cirrhosis caused by other causes.Child A grade 1145 cases,Child B grade 782 cases,Child C grade 503 cases.Among them,119 patients were hepatorenal syndrome patients(44 patients with type I HRS,75 patients with type II HRS),1331 patients with subclinical hepatorenal syndrome(cirrhosis with ascites),and 980 patients with common liver cirrhosis,There were 24 cases of PRA and 23 cases of ATN.2.Comparison between HRS group,subclinical HRS group and Pure liver cirrhosis group: Child scores were statistically significant(P<0.05),HRS group was Child-C was predominant(54%),and subclinical HRS group was Child-B was predominant(44.2%),and the liver cirrhosis group was predominantly Child-A(78.9%).There was no significant difference in the etiology,smoking and drinking between the three groups(P>0.05).The proportion of males in the HRS group(74%)was significantly higher than that in the subclinical HRS group(65.7%)and the cirrhosis group(69.5%).The age of HRS group was greater than that of cirrhosis group and subclinical HRS group,the difference was statistically significant(P<0.05).3.Comparison between HRS group,subclinical HRS group and liver cirrhosis group: NEU,RBC,Urea,Cys-C,?2-MG,ALB,PT,FDP,D dimer were statistically significant(All P<0.05),ALT difference was not statistically significant(P>0.05).The differences in HB,PLT,blood Na,blood CL,blood Ca,TP,PA,AST,GGT,CHE,TBIL,DBIL,TBA,PT-%,INR,APTT between HRS group and subclinical hepatorenal syndrome group was not statistically significant(All P>0.05),and the difference between HRS group and cirrhosis group,subclinical hepatorenal syndrome group and cirrhosis group were statistically significant(P<0.05).The WBC and blood K between HRS group and subclinical hepatorenal syndrome group,subclinical hepatorenal syndrome group and cirrhosis group were significant differences(both P<0.05),but there was no difference between HRS group and cirrhosis group.(P>0.05).There was no significant difference in ALP,FIB and TT between HRS group and subclinical hepatorenal syndrome group,HRS group and cirrhosis group(P>0.05),but there were statistical differences between subclinical hepatorenal syndrome group and cirrhosis group(P<0.05).There were significant differences in Cr and UA between HRS and subclinical hepatorenal syndrome group,HRS and cirrhosis group(P<0.05),However,there was no significant difference between subclinical hepatorenal syndrome and cirrhosis(P >0.05).4.Unconditional logistic regression analysis showed that Urea,Cys-C,?2-MG,Cr,upper gastrointestinal bleeding,hepatic encephalopathy,spontaneous peritonitis,and electrolyte imbalance were independent risk factors for the formation of hepatorenal syndrome.5.Comparison of subclinical HRS,PRA,HRS and ATN:the level of Cys-C,?2-MG,Cr,Urea gradually increased with the degree of renal damage,the difference was statistically significant(P<0.05).6.Spearman correlation analysis showed that Urea,Cys-C and ?2-MG were positively correlated with Cr(P<0.01).7.The ROC curves of Cys-C,?2-MG,Cr,Urea,Cys-C+?2-MG in PRA,subclinical HRS,HRS and ATN groups were drawn.The results showed that the AUC area of combined Cys-C and ?2-MG was higher than Cr,and the combined AUC area was 0.990 in the subclinical HRS group,0.994 in the ATN group,0.931 in the PRA group,and 0.957 in the HRS group.8.According to the optimal cut-off point of ROC curve to test the diagnostic performance of Cys-C,?2-MG,Cr,Urea,Cys-C+?2-MG in HRS group,The results showed that the sensitivity,Specificity,accuracy,true negative rate of combined detection of Cys-C and ?2-MG was higher than Cr(P<0.05).9.The ROC curves of Cys-C,?2-MG,Cr,Urea,Cys-C+?2-MG in type I HRS(HRS-AKI)and type II HRS were plotted.The results showed that the AUC area of Cys-C and ?2-MG combined detection was higher than Cr.The combined AUC area was 0.944 in HRS-AKI group and 0.777 in type II HRS group.Conclusion:1.Urea,Cys-C,?2-MG,Cr,upper gastrointestinal bleeding,hepatic encephalopathy,spontaneous peritonitis,electrolyte imbalance are independent risk factors for the formation of hepatorenal syndrome.In the clinical diagnosis and treatment of liver cirrhosis,patients with elevated levels of Urea,Cys-C,?2-MG,Cr or combined with upper gastrointestinal hemorrhage,hepatic encephalopathy,spontaneous peritonitis,electrolyte imbalance should pay special attention,if necessary,consider Give targeted treatments to avoid the development of HRS.2.The levels of Cys-C and ?2-MG are raised earlier than Cr,It can be used as an indicator of early renal function test of HRS,and its serum level can reflect the degree of kidney injury.3.Whether it is type I HRS or type II HRS,the diagnostic efficiency of Cys-C and ?2-MG is higher than that of Cr.The combined detection can significantly improve the diagnostic efficiency of type I and II HRS.4.Cys-C and ?2-MG can be used as predictors of cirrhosis AKI.The combined detection of the two can help to improve the diagnostic efficacy of cirrhosis AKI.Serum levels can help the differential diagnosis of cirrhosis AKI.