| Objective:Through measuring and analyzing the levels of serum creatinine(Scr)、 blood urea nitrogen (BUN)、creatinine clearance rate (Ccr)、β2-microglobulin (β2-MG)、CystatinC (CysC)) and 99mTc-DTPA renal dynamic imaging of elder patients with malignant tumors before and after chemotherapy, to find a relatively sensitive measurement in monitoring elder cancer patients’ chemotherapy-induced renal function change and to provide a basis for early prevention、diagnosis and treatmen of chemotherapy-induced renal disfunction.Methods:We collected 38 elder patients who were diagnosed with malignant tumor pathologically and received chemotherapy in Tumor Hospital of Yunnan Province from February,2015 to February,2016, measured the levels of Scr、BUN、 Ccr、β2-MG、Cys C before and after the first chemotherapy cycle、the second chemotherapy cycle respectively, measured the glomerular filtration rate (GFR) through 99mTc-DTPA renal dynamic imaging.Then analyze the results of measurement by taking the GFR measured by 99mTc-DTPA renal dynamic imaging as the standard.Results:1.Before these elder cancer patients receiving chemotherapy, the differences of Cys C expressions in different gender、age、ECOG scores and combined disease status groups had no statistical significance.2.The level of Cys C after the first cycle of chemotherapy increred comparing with that before chemotherapy (P=0.001),but the levesl of Scr、BUN、Ccr and β2-MG didn’t change significantly; Comparing with before receiving chemotherapy, the level of Cys C after two cycles of chemotherapy dramatically increred and Ccr、GFR which measured by 99mTc-DTPA renal dynamic imaging decresed(P were 0.000、0.001、0.001 respectively); The level of Cys C befroe the seond cycle of chemotherapy was higher than that befroe the first cycle of chemotherapy, but the levels of Scr、BUN、Ccr and β2-MG didn’t change significantly; The level of Cys C after the seond cycle of chemotherapy was higher than that after the first cycle of chemotherapy, but change of levels of Scr、BUN、Ccr and β2-MG also didn’t have statistical significance.3.There were 22 elder cancer patients whose Scr、BUN、Ccr and Cys C levels were in the normal range before chemotherapy, after the first cycle of chemotherapy, their Cys C level increased above the normal range(>1.09mg/L, P=0.000), but the levels of Scr、BUN、Ccr were also in the normal range and had no significant change comparing with those before chemotherapy. Then continue to receive the second cycle of chemotherapy, Cys C level notably increased than before chemotherapy (P=0.000), Ccr and GFR measured by 99mTc-DTPA renal dynamic imaging dramaticlly decreased (P were 0.003,0.000), Scr, BUN also increaed (P were 0.007、 0.044), however β2-MG didn’t change obviously (P=0.752)4. The 38 elder cancer patients were divided into two groups:20 cases in platinum-containing group and 18 cases in no platinum-containing group. In platinum-containing group, the level of Cys C after the first cycle of chemotherapy increased than before chemotherapy (P=0.011), Scr、BUN、Ccr and β2-MG had no significant change; After the second cycle of chemotherapy, the levels of Cys C、Scr、 BUN increased (P were 0.000、0.039、0.042),Ccr、GFR measured by 99mTc-DTPA renal dynamic imaging decresd than before chemotherapy (P were 0.003、0.001),but β2-MG didn’t change. In no platinum-containing group, there was no significant difference in levels of Scr, BUN、Ccr、β2-MG、Cys C before and after first cycle of chemotherapy; After the second cycle of chemotherapy, the level of Cys C increased、 GFR which measured by 99mTc-DTPA renal dynamic imaging decreased than before the first cycle of chemotherapy (P were 0.013、0.011), but other measurements didn’t change significantly.5. Before chemotherapy, Scr、BUN、Ccr、Cys C all correlated with GFR measured by 99mTc-DTPA renal dynamic imaging, the correlation between Scr, BUN and GFR were low (r were -0.351、-0.326 respectively), the correlation between Ccr、Cys C and GFR were significant (r were 0.558、-0.679), and the the correlation between Cys C and GFR was best; After the second cycle of chemotherapy, Scr、BUN、Ccr、CysC also correlated with GFR, the correlation between Scr, BUN and GFR were low (r were -0.418、-0.369), the correlation between Ccr, Cys C and GFR were significant (r were 0.539、-0.709), and the correlation coefficient between Cys C and GFR was the highest; β2-MG didn’t correlat with GFR either before chemotherapy or after the second cycle of chemotherapy.6.When the levels of Scr、BUN、Ccr、β2-MG and Cys C before chemotherapy were used to predict elder cancer patients who developed a reduction in GFR measured by 99mTc-DTPA renal dynamic imaging of more than 20% after the second cycle of chemotherapy, only the levels of Ccr and Cys C were statistically significant (P were 0.038、0.022). The area under the receiver-operating characteristic curve of Cys C was biggest (AUCROC=0.821), a cutoff point of Cys C 1.07mg/L has sensitivity of 80%、specificity of 81.8% and Youden’s index of 0.618, whic were superior to other measurements.Conclusions:1. Cys C had important clinical significance in monitoring chemotherapy-induced renal function change of elder cancer patients, Cys C was more sensitive than Scr, BUN、Ccr and β2-MG in the aspect of reflecting the early or slightly chemotherapy-induced renal function change. In addition, the correlation between Cys C and GFR is best, the GFR which measured by 99mTc-DTPA renal dynamic imaging was considered as the "gloden standard" of evaluating GFR. Therefor Cys C was a relatively sensitive and accurate measurement in monitoring chemotherapy-induced renal function change of elder cancer patients.2.The level of Cys C of elder cancer patients of who took platinum drugs increased earlier than that of who didn’t took platinum drugs, which indicated elder cancer patients had poor tolerance to platinum drugs, and clinicians should monitor elder cancer patients’ renal function change more closely and take some precautions when they taked platinum drugs. |
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