新胱抑素C-肾小球滤过率公式在老年糖尿病肾病患者中的应用  

Clinical application of Cystatin C-based eGFR equations in the estimation of glomerular filtration rate in elderly type 2 diabetic patients

作　　者：赵雅洁[1] 赵咏桔[1] 沈琳辉[1] 王巍[1] 罗斌钰[1] 缪婕[1] 颜美珠[1] 杨丹英[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院老年病科,200025

出　　处：《中华老年医学杂志》2010年第8期662-666,共5页Chinese Journal of Geriatrics

基　　金：上海市科学技术委员会科研计划项目重点科技攻关（08411951400）

摘　　要：目的 探讨适用于老年糖尿病患者的肾功能估算公式及其与高敏C反应蛋白（hsCRP）联合对老年人肾功能的筛查作用.方法 比较拟合的新估算公式[胱抑素C（Cystatin C）-肾小球滤过率（GFR）,新Cys-eGFR]公式及常用估算公式与同位素测定GFR（iGFR）间的相关性、偏差、相符性及诊断效能,并分析联合hsCRP对该人群中度肾功能下降的筛查作用.结果 新Cys-eGFR公式与iGFR的相关性较好（r=0.767,P＜0.001）,偏差较小（偏差：0.0007）,相符性较高（平均差：21.56）,且诊断中度肾功能下降（iGFR＜60 ml·min-1·1.73 m-2）的灵敏度和特异度也较高（分别为90.7%和88.6%）.新Cys-eGFR公式与hsCRP之间呈较好的负相关性（r=-0.655,P＜0.01）.当取新Cys-eGFR为67.06 ml·min-1·1.73 m-2和hsCRP为5.65 mg/L时,联合两种方法较联合肌酐及尿微量白蛋白/尿肌酐法更敏感（95%对46%）.结论 新Cys-eGFR公式在评估老年糖尿病肾病患者病程进展中具有一定的应用前景,联合hsCRP能早期筛查中度肾功能下降者.Objective To explore the most suitable equation in accessing renal function for the elderly type 2 diabetic patients, and its clinical utility in combination with hypersensitive C-reactive protein （hsCRP）. Methods The new Cystatin C-based equations for estimated glomerular filtration rate （Cys-eGFR） and conventional predictive equations were compared with isotopic GFR （iGFR） by linear regression analysis, paired t-test, Bland and Altman procedures and non-parametric receiver operating characteristic （ROC） curves. The new Cys-eGFR equation and hsCRP were also incorporated for detecting renal disease in this population. Results The new Cys-eGFR equation had a better relativity with iGFR （r= 0.767, P〈0.001）, a less bias （bias： 0.0007, P〉0.05）, a higher conformance （2SD： 21.56）, higher sensitivity （90.7%） and specificity （88.6%） for diagnosing moderate decrease in renal function. There was a negative relationship between the new Cys-eGFR and hsCRP （r=-0.655, P〈0.01）. When the new Cys-eGFR was 67.06 ml· min-1 ·1.73 m-2 and hsCRP was 5.65 mg/L, the combination of Cys-eGFR and hsCRP was better than the combination of serum creatinine and urine albumin/creatinine ratio in screening stage 3 chronic kidney disease （95%vs.46%）. Conclusions The combination of new Cys-eGFR equation and hsCRP may screen an early decrease of moderate GFR.

关 键 词：糖尿病肾病 肾小球滤过率 半胱氨酸蛋白酶抑制剂 C反应蛋白质 

分 类 号：R587.2[医药卫生—内分泌]