胱抑素C测定在腹膜透析患者残余肾功能评价中的应用价值  

Serum cystain C as a new marker for the estimation of glomerular filtration rate in peritoneal dialysis patients

作　　者：俞雨生[1] 周岩[1] 张炯[1] 陈婷[1] 王生余[1] 王金泉[1] 唐政[1] 黎磊石[1] 

机构地区：[1]南京军区南京总医院解放军肾脏病研究所,江苏南京210002

出　　处：《医学研究生学报》2008年第7期722-726,共5页Journal of Medical Postgraduates

摘　　要：目的：探讨血清胱抑素C（Cys C）与血肌酐（SCr）等反映透析充分性指标之间是否存在相关性,评价其在判断腹膜透析（PD）患者残余肾功能（RRF）状态及透析效能的临床应用价值。方法：选取2006年5月至2007年11月间行PD治疗、病情稳定的118例患者。所有患者在透析过程中,每3个月进行一次临床随访,全面评估患者的全身情况改变,包括Cys C、体表面积（BSA）、尿量（UV）、尿素氮（BUN）、SCr等。测定每周总尿素氮清除率（totalKT/V urea）、每周肌酐总清除率（total weekly CCr）、蛋白质表现率（nPNA）来判断透析效能。RRF以残余肾肌酐清除率（rGFR）表示。按有无尿量分为两组,分别检查Cys C、SCr判断有无RRF,绘制受试者工作特性曲线（ROC）,并求其曲线下面积（AUC）。结果：男性患者平均Cys C为（5.87±1.84）mg/L,女性患者为（5.17±1.4）mg/L（t=-2.31,P=0.02）。男性患者SCr为（8.15±3.29）mg/L,女性患者为（8.65±4.2）mg/L（t=0.6,P=0.08）。将rGFR按〈1、1.1~4、4.1~8和〉8 ml/min×1.73 m2分为四组,Cys C及SCr分别为（6.88±1.49）、（5.67±0.93）、（4.68±0.79）和（3.61±1.01）mg/L以及（12.8±5.25）、（9.3±2.49）、（6.08±1.82）和（4.12±1.46）mg/L。Cys C及SCr与rGFR呈显著负相关（r=-0.66,P〈0.05及r=-0.59,P〈0.05）。Cys C与total CCr（r=-0.64,P〈0.05）,以及total KT/V urea（r=-0.57,P=0.05）亦呈明显负相关,与nPNA（r=-0325,P〉0.05）不相关。SCr与total CCr（r=-0.57,P〈0.05）、total KT/V urea（r=-0.554;P=0.01）、nPNA（r=-0.132,P=0.01）呈明显负相关。Cys C与SCr的相关系数为0.65,P〈0.05。ROC曲线显示有尿及完全无尿两组患者Cys C及SCr的AUC曲线完全一致,前者分别为0.921vs0.858,后者为0.707vs0.545,Cys C较SCr更敏感。结论：血清Cys C水平与PD患者的RRF有密切的关系,在判断PD患者RRF方面较SCr更为敏感,而且结果更加稳定,可作为判断PD患者RRF及透析效能变�Objective ： Cystatin C （ Cys C） is a nonglycosylated protein of low molecular weight not influenced by age, sex or inflammation. The aim of this paper is to ascertain the usefulness of the serum Cys C level determination in peritoneal dialysis （PD） patients. Methods： Cys C serum levels were determined in 118 PD patients aged （45.7 ± 15.7） years and with （ 13.8 ± 15.8） months on PD, 37% on continuous ambulatory peritoneal dialysis （DAPD） and 63% on daytime ambulatory peritoneal dialysis （DAPD）. Cys C, the body surface area （BSA）, the urinary volume （UV）, blood urea nitrogen （BUN） and serum creatinine （SCr） were measured for all the patients every 3 months, and the total weekly Kt/ V urea, creatinine clearance （Ccr） and normalized protein nitrogen appearance （nPNA） were determined for the assessment of the PD efficacy. Residual renal function （RRF） was indicated by the residual glomerular filtration rate （rGFR）. The presence or absence of RRF was detected and the receiver operating characteristic curve （ROC） was used to obtain the area under the curve （AUC）. Results： The mean Cys C level was （5.42 ± 1.5） mg/L, significantly higher in the anuric （ [6.9±1.5 ] mg/L） than in the non-anuric patients （ [4.6 ±1.3 ] rag/L, P 〈 0. 001 ） , with no correlation to age, BSA or time of PD, and inversely correlated with rGFR （ r = - 0.66, P 〈 0. 001 ） and residual urine volume （ r = -0.59, P 〈0. 001 ）. Serum Cys C concentration was also inversely correlated with total weekly Ccr （ r = - 0.64 ; P 〈 0. 001 ） and total Kt/V urea （ r = - 0.57 ; P = 0.01 ）. In a multiple regression model, the body weight, normalized protein catabolic rate and RRF had independent effects on serum Cys C. Conclusion： Compared with SCr, the serum Cys C level is more closely correlated with and more sensitive in the estimation of RRF, and therefore can be used as a new marker of rGFR for PD patients.

关 键 词：胱抑素C 残余肾功能 腹膜透析 肌酐 肾小球滤过率 

分 类 号：R459.5[医药卫生—治疗学]