Objective To investigate the value of serum cystatin C( Cys C) in the diagnosis of early renal injury in patients with viral hepatitis. Methods A retrospective analysis was performed for the clinical data of 270 patients with chronic hepatitis B virus( HBV) or hepatitis C virus( HCV) infection. According to the fibrosis degree determined by FibroScan,the patients were divided into non-significant liver fibrosis group( F0-F2),significant liver fibrosis group( F2-F3),progressive liver fibrosis group( F3-F4),and liver cirrhosis group( >F4). The four groups were compared in terms of urea nitrogen,creatinine,Cys C,and estimated glomerular filtration rate( e GFR). The t-test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for further comparison between two groups. A Pearson correlation analysis was used to investigate correlation. Results Among the 270 patients,200 had HBV infection and 70 had chronic HCV infection. There were significant differences in e GFR and Cys C between the four groups( F = 2. 714 and 3. 081,P = 0. 032 and 0. 017). Further comparison between two groups showed that the liver cirrhosis group had a significantly lower eGFR than the non-significant liver fibrosis group( 99. 61 ± 6. 92 ml·min-1·1. 73 m-2 vs 105. 32 ± 1. 86 ml·min-1·1. 73 m-2,t = 2. 655,P = 0. 008); compared with the non-significant liver fibrosis group,the other three groups had significant increases in the serum level of Cys C( significant liver fibrosis group: 1. 01 ± 0. 08 mg/L vs 0. 84± 0. 03 mg/L,t =-2. 218,P = 0. 028; progressive liver fibrosis group: 1. 02 ± 0. 04 mg/L vs 0. 84 ± 0. 03 mg/L,t =-4. 218,P < 0. 001;liver cirrhosis group: 1. 07 ± 0. 05 mg/L vs 0. 84 ± 0. 03 mg/L,t =-4. 675,P < 0. 001). For the patients with HBV or HCV infection,the patients with liver cirrhosis had a significantly higher serum level of Cys C than those without significant liver fibrosis( patients with HBV infection: 1. 06 ± 0. 36 mg/L vs 0. 84 ± 0. 13 mg/L,t =-3. 192,P = 0. 003; patients with HCV infection: 1. 04 ± 0. 22 mg/L vs 0. 86 ± 0.15 mg/L,t =-2. 318,P = 0. 029). Liver stiffness measurement was positively correlated with the serum level of Cys C( r = 0. 247,P = 0.003),while there was no correlation between liver stiffness measurement and eGFR( r =-0. 002,P = 0. 975). Conclusion Cys C can be used for the diagnosis of early renal injury in patients with viral hepatitis,and regular monitoring of Cys C level has a positive significance in the prevention and treatment of hepatorenal syndrome in such patients.
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