RESUMO
BACKGROUND: Serum creatinine (SCr) is the most commonly used parameter to estimate renal function impairement, but there are some shortcomings. Many factors including age, gender, drug, diet, muscle mass and metabolic rate can influence SCr, leading to an inaccurate estimation of kidney impairment. Studies have shown that cystatin C (CysC) is not affected by factors such as muscle mass, age, gender, diet, inflammation or tumor. The present study was undertaken to compare the sensitivity of CysC and SCr in evaluating renal function impairment at early stage of shock. METHODS: Seventy-one patients aged 38.3±21.4 years, who had been treated at the Emergency Medicine Department of the First Affiliated Hospital, Sun Yat-sen University between February 2006 and June 2007, were studied. They were divided into groups A, B, C, and D according to the shock time. Serum sample was drawn from each patient at 1, 2, 3, 4 hours after shock to determine SCr and CysC. CysC and SCr were determined again at 72 hours and 7 days after shock. RESULTS: CysC increased earlier than SCr in the 71 patients, and CysC decreased slower than SCr when shock was corrected. CysC increased at 1 hour after shock. There was a negative correlationship between CysC, SCr and glomerular filtration rate (GFR), especially at early stage of shock. CONCLUSIONS: There is renal injury at early stage of shock. CysC is more sensitive than SCr in assessing renal function at the early stage of shock.
RESUMO
Objective To observe the effects of mild hypothermia on the heat shock protein 70 (HSP70), interlukin 6 (IL-6) and tumor necrosis factor-α (TNF-α) in blood and cerebrospinal fluid in patients with cerebroma and explore the molecular mechanism of hypothermia on cerebral ischemia. Methods Forty patients, selected for cerebroma resection under microscopy, were randomized innormothermia group (n=20, 36.6±0.4 ℃) and hypothermia group (n=20,34.8±0.6 ℃). These temperatures were guaranteed by air temperature control blanket. Jugular venous blood and cerebrospinal fluid were collected before the anesthesia induction (T1), 1 h after opening the endocranium (T2) and 24 h after the operation (T3). The content of HSP70, IL-6 and TNF-α in the blood and cerebrospinal fluid was measured by ELISA, and the results were statically analyzed. Results The core temperature in the hypothermia group was decreased significantly from starting the operation to the end of tumor resection as compared with that in the normothermia group (P<0.05). The level of HSP70 in blood or cerebrolspinal fluid presented an increasing trend in both groups, and the level of HSP70 at T2 and T3 in the hypothermia group was significantly higher than that in the normothermia group (P<0.05). Compared with those in the normothermia group, the levels of IL-6 and TNF-α in blood or cerebrospinal fluid at T2 and T3 in the hypothermia group were significantly lower (P<0.05). At T1 and T2 in the normothermia group, the content of HSP70 in cerebrospinal fluid was obviously higher than that in blood (P<0.05).Conclusion Mild hypothermia can increase the expression level of HSP70 in blood and cerebrospinal fluid and decrease the level of IL-6 and TNF-α in blood and cerebrospinal fluid. HSP70 in cerebrospinal fluid might be more sensitive than that in blood in presenting the brain injury.