冠状病毒病程的临床和实验室特征以及住院病人的胱抑素 C 水平

S. Mahiiovych, T. Maksymets, E. Sklyarov
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摘要

冠状病毒病的病程通常伴有肾功能障碍,这是糖尿病、高血压和其他肾脏疾病并发的结果。监测肾脏状况最常用、最经济的方法是测定肌酐水平和计算肾小球滤过率。然而,血清胱抑素 C 水平是评估肾功能的 "金标准"。本研究旨在检查冠状病毒病的临床和实验室方面,并确定住院患者胱抑素 C 与肾功能之间的相关性。研究共涉及 79 名冠状病毒病患者,年龄从 24 岁到 73 岁不等。其中女性占 40.5%,男性占 59.5%。所有患者均按照乌克兰批准的现行冠状病毒病治疗方案进行治疗。此外,为了评估肾功能障碍,还使用 SPINREACT 测试系统(西班牙)对胱抑素 C 进行了生化测定。结果显示肌酐水平为 123.0 (96.0; 151.0) μmol/l。肾小球滤过率为 52 (42,5; 71,0) ml/h/l.73m2,表明存在肾功能障碍。胱抑素 C 浓度为 1,27 (0,81; 1,87) mg/l。胱抑素 C 与肌酐浓度相关(r = 0,62,p < 0,05),与肾小球滤过率呈负相关(r = -0,65;p < 0,05),与肌酐不同的是,胱抑素 C 的水平与年龄和性别无关。未来胱抑素 C 浓度的升高可能成为冠状病毒病严重病程的预后标志,而不仅仅是肾功能障碍的预后标志。结论入院时的临床表现和实验室参数取决于病前背景,并以出现以下综合征为特征:全身炎症反应、呼吸衰竭、高凝状态和肾功能障碍。胱抑素 C 水平升高是肾功能障碍的指标,也是严重冠状病毒病的预后标志。
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Clinical and laboratory features of the course of the coronavirus disease and the level of cystatin C in hospitalized patients
The course of coronavirus disease is often accompanied by renal dysfunction, which is the result of comorbid pathology, namely diabetes mellitus, hypertension and precisely nephrological diseases. The most common and affordable way to monitor the condition of the kidneys is by determining the level of creatinine and calculating the glomerular filtration rate. However, serum cystatin C level is the «gold standard» for assessing renal function. This study aims to examine the clinical and laboratory aspects of coronavirus disease and establish the correlation between cystatin C and kidney function in hospitalized patients. 79 patients with coronavirus disease ranging from 24 to 73 years were involved in the study. The percentage of women in the group was 40,5%, while the percentage of men was 59,5%. The current protocol for the treatment of coronavirus disease, approved in Ukraine, was followed by all patients. Additionally, to assess renal dysfunction, cystatin C was determined biochemically using the SPINREACT test system (Spain). Results. Creatinine level was 123.0 (96,0; 151,0) μmol/l. Glomerular filtration rate was 52 (42,5; 71,0) ml/h/l.73m 2 , suggesting renal dysfunction. The cystatin C concentration was 1,27 (0,81; 1,87) mg/l. Cystatin C correlated with creatinine concentration (r = 0,62, p < 0,05) and negatively correlated with GFR (r = -0,65; p < 0,05), while, unlike creatinine, its level did not depend on age and gender. Increasing the concentration of cystatin C in the future could be a prognostic marker for the severe course of coronavirus disease, not just for renal dysfunction. Conclusions. Clinical manifestations and laboratory parameters during hospital admission depended on the premorbid background and were characterized by the presence of the following syndromes: systemic inflammatory response, respiratory failure, hypercoagulation and renal dysfunction. An elevated level of cystatin C is an indicator of kidney dysfunction, as well as a prognostic marker of severe coronavirus disease.
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