血清半胱氨酸蛋白酶抑制剂C对高血压患者早期肾损伤的诊断性能评价  

Evaluation of the diagnosis value of serum cystatin C for early renal impairment in patients with hypertension

作　　者：欧阳旭 陈汉红[2] 云大壮[2] 吴璐思[2] 张敏[2] 

机构地区：[1]宁远县人民医院检验科,湖南宁远425600 [2]广东省医学科学院广东省人民医院病理医学部检验科,广东广州510080

出　　处：《检验医学》2011年第5期317-320,共4页Laboratory Medicine

摘　　要：目的评价血清半胱氨酸蛋白酶抑制剂C(Cys C)对高血压患者早期肾损伤的诊断价值,为Cys C在临床的应用提供循证医学证据。方法对318例原发性高血压并怀疑合并早期肾损伤的患者同时进行血清Cys C和99mTc-二乙三胺五醋酸(99mTc-DTPA)清除率的检测。以99mTc-DTPA清除率为诊断标准将318例患者分为肾损伤组(127例)和对照组(191例)。用受试者工作特征(ROC)曲线选取血清Cys C诊断原发性高血压患者早期肾损伤的最佳临界点,计算敏感性、特异性、Youden指数等指标,评价血清Cys C诊断原发性高血压患者早期肾损伤的真实性。同时做血清Cys C检测的重复性试验,评价血清Cys C检测方法的可靠性。结果根据ROC曲线,Cys C诊断原发性高血压患者早期肾损伤的最佳临界点为1.26 mg/L,其敏感性为84.3%、特异性为79.1%、阳性预测值为72.8%、阴性预测值为88.3%、阳性似然比为4.03、阴性似然比为0.20、漏诊率为15.7%、误诊率为20.9%、总符合率为81.1%、Youden指数为0.63、ROC曲线下面积[95%可信区间(CI)]为0.855(0.814～0.896)。当Cys C日平均均值分别为1.21、1.67 mg/L时,该法的批内变异系数(CV)分别为2.9%、2.7%,批间CV分别为3.6%、3.3%,日间CV分别为4.1%、3.8%,总CV分别为7.0%、6.4%。结论血清Cys C对原发性高血压患者早期肾损伤有较好的诊断价值,尤其适合早期筛查。Objective To evaluate the clinical significance of serum cystatin C（Cys C） in early renal impairment in patients with hypertension,and provide the reference for Cys C in the clinical application.Methods 318 patients with primary hypertension and suspected early renal impairment were enrolled.Serum Cys C and the clearance of 99mTc-diethy lenetriaminepentaacetic acid（99mTc-DTPA） were determined.318 patients were classified into 2 groups according to the clearance of 99m Tc-DTPA（renal impairment group： 127 cases and control group： 191 cases）.The receiver operating characteristic（ROC） curve was used to confirm the cut-off value,and the sensitivity,specificity and Youden index were calculated.The accuracy of diagnosing the early renal impairment by serum Cys C was evaluated.The repeatability was assessed simultaneously,and the reliability was analyzed.Results According to the ROC curve,the best cut-off value of diagnosing patients with primary hypertension and early renal impairment was 1.26 mg/L.The sensitivity and specificity were 84.3% and 79.1%.The positive and negative predictive values were 72.8% and 88.3% respectively.The positive and negative likelihood ratios were 4.03 and 0.20.The rate of missed diagnosis was 15.7%,and the misdiagnosis rate was 20.9%.The total coincidence and Youden index were 81.1% and 0.63.The area under ROC curve [95% confidence interval（CI）] was 0.855（0.814-0.896）.When the daily mean of Cys C was 1.21 and 1.67 mg/L,the within-run coefficient of varication（CV） were 2.9% and 2.7%,and the between-run CV were 3.6% and 3.3%.The daytime CV were 4.1% and 3.8%,and the total CV were 7.0% and 6.4%.Conclusions Serum Cys C has significant diagnosis value for early renal impairment in primary hypertension patients,and it is suitable for early screening.

关 键 词：半胱氨酸蛋白酶抑制剂C 高血压 肾功能试验 肾小球滤过率 

分 类 号：R446.1[医药卫生—诊断学]