| At present, cadaveric donor kidney in our country is dwindling, living donor kidney has become an important source of the renal transplant. However, after become an acquired unitesticle patient, single kidney can bring some potential risks because of the reserves lacking of organ function in a short or long term. And the other unitesticle patients who have become acquired unitesticle after renal illness such as renal abscess, renal hemorrhage, and renal atrophy, they have similar renal kidney function mechanism to the donor kidney transplantation. So follow-up this patient’s renal function changes can also be reflected in the donor kidney transplantation.The serum cystatin C (CysC) which was found in recent years is considered to be an ideal endogenous indicators to estimate the glomerular filtration rate (GFR). Many researches’ results showed that cystatin C is an accurate and sensitive indicator to value the renal function during renal diseases.Objective:Preliminarily study the relationship between renal function change and cystatin C in long-term follow-up for the acquired unitesticle patients. Inquire into the feasibility of cystatin C estimate early renal damage in acquired unitesticle patients.Methods:Detected serum cystatin C and serum creatinine(Scr) of the selected81cases of the acquired unitesticle patients. The creatinine clearance(Ccr)was calculated followed the Cockcroft-Gault formula, and corrected by body surface area1.73m2to estimate GFR. According to different level of Ccr (mL/min/1.73m2), the patients were divided into4groups:group1:Ccr≥80mL/min/1.73m2belongs to normal; group2:50<Ccr<80mL/min/1.73m2is mild renal function impairment; group3:30<Ccr＜50mL/min/1.73m2is moderate renal function impairment; group4: Ccr<30mL/min/1.73m2is severe renal function impairment. Meanwhile,40healthy people who have a normal renal function and not unitesticle was choosed as controls, detecting thier serum creatinine, cystatin C. Using the software SPSS13.0to analyse data. The correlations among CysC, Scr and Ccr were compared by using Pearson correlation analysis. In order to compare the diagnostic value of CysC and Scr, through calculated the receiver operating charateristiccurve(ROC) to obtain and analyze the sensitivity(Se) and specificity(Sp) of CysC and Scr.Results:1.The average levels of Scr and CysC in all81patients were109.23±49.65μmol/L,1.56±0.80mg/L. The average serum levels of CysC in40healthy control individual were1.01±0.12mg/L. The CysC and Scr in group1(Ccr≥80mL/min/1.73m2) had no significant difference compared with the group of healthy control(P>0.05).2. In all81patients, Scr was significant negatively correlated with Ccr (r=-0.832, P＜0.01), CysC was significant negatively correlated with Ccr(r=-0.862, P＜0.01), Scr was significant positive correlated with CysC(r=0.872, P＜0.01). Moreover, the overall correlation between CysC and Ccr were significantly higher than that of Scr and Ccr(P＜0.05). In order to compare the diagnostic value of CysC and Scr, the ROC was calculated to obtain and analyze the sensitivity, specificity, likelihood ratios(LR) of CysC and Scr, the area under the curve (AUC) of CysC and Scr were0.944and0.890(P<0.05), in their respective optimal cut-off, the sensitivity and specificity of CysC respectively were91.7%and89.8%, better than that of Scr85.9%and88.4%, there was significant difference between Se (P＜0.05).3. In the first group (Ccr≥80mL/min/1.73m2), Scr was significant negatively correlated with Ccr(r=-0.658, P＜0.01). CysC was significant negatively correlated with Ccr(r=-0.646, P＜0.01). Scr was significant positive correlated with CysC(r=0.715, P＜0.01). However, the correlation between Scr and Ccr is not obviously stronger than that between CysC and Ccr (P>0.05).4. In the second group (50<Ccr<80mL/min/1.73m2), Scr was significant negatively correlated with Ccr(r=-0.570, P＜0.01). CysC was significant negatively correlated with Ccr(r=-0.772, P＜0.01). Scr was significant positive correlated with CysC(r=0.570, P＜0.01). Moreover, the correlation between CysC and Ccr were significantly higher than that of Scr and Ccr(P<0.05). In order to compare the diagnostic value of CysC and Scr, the ROC was calculated to obtain and analyze the sensitivity, specificity, likelihood ratios of CysC and Scr,the AUC of CysC and Scr were0.936and0.833(P<0.05), in their respective optimal cut-off, the sensitivity and specificity of CysC respectively were89.7%and88.6%, better than that of Scr79.4%and84.1%. And it had a significant difference between their Se (P＜0.05).5. In the third group (30≤Ccr＜50mL/min/1.73m2), Scr was significant negatively correlated with Ccr(r=-0.909, P＜0.01). CysC was significant negatively correlated with Ccr(r=-0.897, P＜0.01). Scr was significant positive correlated with CysC(r=0.911, P<0.01). However, the correlation between Scr and Ccr is not obviously stronger than that between CysC and Ccr (P>0.05).In order to compare the diagnostic value of CysC and Scr, the ROC was calculated to obtain and analyze the sensitivity, specificity, likelihood ratios of CysC and Scr. The AUC of CysC and Scr were0.912and0.933(P>0.05), in their respective optimal cut-off, the sensitivity and specificity of CysC respectively were89.9%and91%, similar to that of Scr91.5%and91.3%. The Se and Sp between Scr and CysC also had no significant difference(P>0.05).6. In the fourth group (Ccr<30mL/min/1.73m2), Scr was no significant negatively correlated with Ccr(r=-0.565, P>0.05). CysC was no significant negatively correlated with Ccr(r=-0.676, P>0.05). But Scr was significant positive correlated with CysC(r=0.981, P＜0.05). In order to compare the diagnostic value of CysC and Scr, the ROC was calculated to obtain and analyze the sensitivity, specificity, likelihood ratios of CysC and Scr, the AUC of CysC and Scr were0.978and0.990(P>0.05), in their respective optimal cut-off, the sensitivity and specificity of CysC respectively were96.1%and100%, similar to that of Scr97.4%and100%. The Se and Sp between Scr and CysC also had no significant difference(P>0.05).Conclusion:1. In the renal function evaluation of long-term follow-up to the acquired unitesticle patient, cystatin C correlate well with Scr and Ccr. In the renal function damage patients especially mild damage, the correlation between CysC and Ccr is better than Scr and Ccr. 2. To the discovery of mild renal function damage, the sensitivity of CysC was higher than Scr, and their specificity was similar. So CysC can more timely discover the early renal function damage than Scr in the acquired unitesticle patient.3. In moderate and severe renal function impairment of the acquired unitesticle patient, the diagnostic efficiency of Cys C is not better than Scr.4. Cystatin C could be used as a judgment index to estimate the renal function of long-term follow-up to the acquired unitesticle patient, having the advantages of high sensitivity, good specificity and convenient detection. Especially for the evaluation of diagnose the mild renal function impairment, it has obvious advantages compared with Scr.5. To determine CysC by PENIA has the characters of convenience, quickness, low expense. CysC can be used as an ideal marker of GFR for clinical monitoring. |
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