胱抑素C评价早中期慢性肾脏病患者肾功能损害的临床价值  

The clinical value of cystatin C in the assessment of renal injury of patients with chronic kidney disease at the early and middle stage

作　　者：陈结慧 祝胜郎 叶玲 朱恒梅 李向阳 蒋莹 李就鸿 

机构地区：[1]深圳市第六人民医院肾内科,广东深圳518052

出　　处：《热带医学杂志》2011年第8期927-930,共4页Journal of Tropical Medicine

基　　金：深圳市南山区科技局基金(南卫2008036)

摘　　要：目的探讨血清胱抑素C(CysC)评价早中期慢性肾脏病(CKD)患者肾功能损害的临床价值。方法以2008年1月至2010年12月深圳市第六人民医院肾内科住院治疗的221例CKD1～3期患者为观察对象,测定CysC、血肌酐(SCr)、血尿素氮(BUN)、血尿酸(BUA)及血白蛋白(Alb),与MDRD公式计算的肾小球滤过率(GFR)进行比较。结果 CKD1～3期患者CysC随着GFR的下降而升高,各组间比较差异有统计学意义(P<0.05);血清CysC水平与SCr、BUN及BUA水平呈明显正相关(r=0.650,P=0.000;r=0.631,P=0.000;r=0.309,P=0.000),与GFR水平呈明显负相关(r=-0.717,P=0.000)。CKD2期患者CysC异常检出率为32.8%,SCr为0;CKD3期患者CysC异常检出率为73.0%,SCr为58.4%,CKD3期患者CysC、SCr的异常检出率差异有统计学意义(P<0.05)。CysC评估GFR的接受者操作特征曲线下面积(AUCROC)为0.853,敏感性为0.780,特异性为0.817;SCr的AUCROC为0.924,敏感性为0.793,特异性为0.958;联合CysC和SCr后,AUCROC上升至0.940,敏感性为0.853,特异性为0.950。结论 CysC是评估早中期CKD患者肾功能损害的敏感指标,联合应用CysC和SCr可提高对早中期慢性肾功能不全患者的诊断效能。Objective To explore the clinical value of cystatin C （Cys C） in the assessment of renal injury of patients with chronic kidney disease at the early and middle stage.Methods A total of 221 patients with CKD stage 1-3 were enrolled in this study.Serum Cys C,serum creatinine （SCr）,blood urea nitrogen （BUN）,serum uric acid （BUA） and albumin （Alb） were tested,and compared with estimated glomerular filtration rate （GFR） based on MDRD formula.Results Serum Cys C increased while GFR decreased in different groups,the level of serum Cys C and GFR were significantly different（P0.05）.Serum Cys C was positively correlated with SCr （r=0.650,P=0.000）,BUN （r=0.631,P=0.000） and BUA（r=0.309,P=0.000）,and negatively correlated with GFR（r=-0.717,P=0.000）.The percentage of patients with elevating level of Cys C with CKD at stage 2 and stage 3 were 32.8% and 70%,respectively,while with the increasing level of SCr were 0 and 58.4%,respectively（P0.05）.The AUCROC for Cys C and SCr were 0.853 and 0.924,respectively.An increase of AUCROC （0.940） was observed when combined Cys C with SCr.Conclusions Cys C is a sensitive marker to detect mild and middle renal insufficiency.Combination of the used of Cys C and SCr as the indicator may improve the diagnostic efficacy for patients with chronic kidney disease at the early and middle stage.

关 键 词：胱抑素C 慢性肾脏病 肌酐 肾功能损害 

分 类 号：R692.5[医药卫生—泌尿科学]