血清β痕迹蛋白对肾小球滤过功能的评估  

Evaluation of glomerular filtration rate using serum beta-trace protein in patients with renal diseases

作　　者：陈晓农[1] 史浩[1] 朱杰[2] 倪莉燕[1] 张文[1] 王伟铭[1] 潘晓霞[1] 陈楠[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院肾脏科,上诲100015 [2]上海师范大学数理信息学院,上海200234

出　　处：《肾脏病与透析肾移植杂志》2008年第1期38-42,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：上海市卫生局重大课题(2003ZD002);上海市卫生局重点学科(05III001);上海市重点学科(特色)(T0201)

摘　　要：目的:研究血清β痕迹蛋白(βtrace protein,BTP)在肾小球滤过功能评估中的价值。方法:收集2004年2月至2005年4月间我科住院的慢性肾脏病患者108例,男:57例,女:51例,平均年龄(50.39±15.37)岁,以改进的免疫比浊法,测定BTP浓度。同时检测血肌酐(SCr)、血清胱抑素C(cystatin,CysC)、同位素99mTc-GFR(GFR),并用CG公式计算肌酐清除率(Ccr)、MDRD公式计算肾小球滤过率(eGFR)。以GFR为金指标,对上述检测方法行相关分析及受试者工作特征曲线(ROC曲线)分析,计算ROC曲线下面积(AUC),比较各种检测方法的准确性,用四格表的卡方检验进行关联性的研究。结果:108例患者,血清BTP、Cys C、Ccr、eGFR和SCr的检测结果与GFR比较具有很好的相关性,相关系数分别为:-0.70、?0.82、0.79、0.81和?0.67,P均<0.01。BTP、CysC、eGFR、Ccr、SCr的AUC分别为0.913、0.889、0.878、0.864、0.846。在GFR<90 ml/min时,BTP、Cys C、Ccr、eGFR、SCr的诊断符合率分别是:86.11%、86.11%、92.59%、89.81%,72.22%。在GFR<60 ml/min时,其他指标的诊断符合率分别是BTP:81.5%、Cys C:79.6%、Ccr:76.8%、eGFR:77.7%,SCr:81.5%。结论:Ccr、eGFR与同位素99mTc-GFR等具有良好的相关性;BTP敏感性优于SCr;BTP检测方法简便快速,可作为评价肾功能不全的一项新指标,但仍需进一步研究。Objective：To evaluate the validity of serum beta-trace protein （BTP） as a marker of renal function in patients with various renal diseases and compare with other markers of glomerular filtration rate （GFR）. Methodology： One hundred and eight hospitalized chronic kidney disease （CKD） patients from February of 2004 to April of 2005 were enrolled in this study. Blood samples were obtained to detect serum creatinine （SCr）, Cystatin C （CysC） and BTP （it was determined by latex particle enhanced turbidimetry using a newly developed nephelometric research assay on a Dade Behring BN ProSpec analyzer, Dade Behring, Marburg, Germany）. GFR was estimated using the Cockcroft-Gault （CG） formula and MDRD formula （ Modification of Diet in Renal Study Group）. Isotope ^99mTc-GFR was also performed in all patients as the standard criterion of GFR. Results ：108 patients [57 male, 51 female, with mean age （50. 4 ± 15.4）yrs] were ineluded. Serum fliP, CysC, CG-Ccr, MDRD-GFR and SCr correlated significantly with ^99mTc-GFR. The correlation coefficients r = -0. 70,-0. 82,0. 79,0. 8 and -0. 67 ,P 〈0. 01. The diagnostic validity was evaluated by the ROC curve analysis. The ROCAUC （the area under the receiver operating curve） of BTP, Cys C, simplified MDRD-GFR, CG-Ccr and SCr were 0. 913,0. 889,0. 878,0. 864,0. 846, respectively. The area under the BTP curve was larger than those under other curves, demonstrating a higher power of discrimination. Among ^99mTc-GFR 〈 90 ml/min. 1.73m^2 patients, which was considered as the lower cutoff limit of GFR, the diagnostic consistence of BTP was 86. 1%, Cys C： 86. 1%, CG-Ccr： 92.6% ,MDRD-GFR：89. 8% ,SCr：72. 2%. When ^99mTc-GFR 〈60 ml/min. 1.73 m^2 as the lower cutoff limit of GFR, the diagnostic consistence of BTP was 81.5% ,Cys C：79.6% ,CG-Ccr：76. 8% ,MDRD-GFR：77.7%, SCr：81.5%. Conelusion：BTP, CysC, the CG-formula, the MDRD-formula and SCr are comparable markers representing renal function in patients with various CKD. We suggest

关 键 词：血清β痕迹蛋白 肾小球滤过功能 慢性肾脏病 评价指标 

分 类 号：R692.6[医药卫生—泌尿科学]