基于半胱氨酸蛋白酶抑制素C建立的肾小球滤过率估算公式对于2型糖尿病患者肾功能的评估价值  

Application of Cystatin C-based formulas for estimation of glomerular filtration rate in type 2 diabetic patients

作　　者：杨帆[1] 李丽[1] 孙爱华[1] 马蔚芸[1] 陆怡德[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院检验科,上海200025

出　　处：《诊断学理论与实践》2012年第3期290-294,共5页Journal of Diagnostics Concepts & Practice

摘　　要：目的:探讨基于半胱氨酸蛋白酶抑制素C(Cys C)建立的肾小球滤过率(GFR)估算公式在我国2型糖尿病患者肾功能评估中的适用性。方法:采用颗粒增强散射免疫比浊法(PENIA)和颗粒增强透射免疫比浊法(PETIA),对Cys C检测进行方法学比较。收集158例2型糖尿病患者的相关资料,行核素99m锝-二乙三胺五乙酸(99mTc-DTPA)肾动态显像检测肾小球滤过率(iGFR)作为GFR的参考标准。PETIA和PENIA检测血清Cys C浓度,并应用Grubb公式、Stevens公式、Rule公式及Macisaac公式估算GFR,结果与iGFR进行一致性、偏差程度和15%、30%、50%符合率的比较。结果:PENIA与PETIA这2种方法间的检测结果呈显著相关(r=0.986),且医学决定水平浓度处的系统误差在临床可接受范围。158例2型糖尿病患者的iGFR为(96.42±28.93)mL·min-1·(1.73m2)-1,血清Cys C质量浓度中位数为0.85 mg/L(0.46～4.32 mg/L)。各公式的肾小球滤过率估算值(eGFR)与iGFR均存在相关,将eGFR与iGFR分别进行Bland-Altman分析,Rule公式及Macisaac公式较Grubb公式和Stevens公式与iGFR的偏离度较小(P>0.05),存在良好的一致性。4个公式eGFR与iGFR15%、30%和50%符合率不尽相同,Macisaac公式在iGFR≥90 mL·min-1·(1.73m2)-1时15%符合率超过65%。结论:4个基于Cys C建立的GFR估算公式估算2型糖尿病患者肾功能水平时存在差异;临床应考虑估算公式建立初的研究人群,综合种族、年龄、病种等多方面因素选择合适的估算公式,才能更好地评估患者的肾功能水平。Objective To investigate the applicability of using Cys C-based formulas for estimation of GFR in Chinese type 2 diabetic patients.Methods Firstly,the accuracy of two assays（PETIA and PENIA） for Cystatin C was evaluated.Then 158 type 2 diabetic patients were collected for determination of serum Cystatin C level and renal clearance of 99mTc-DTPA,which was used as the reference of glomerular filtration rate.Cystatin C was measured by PETIA and PENIA,and the results of eGFR calculated by Grubb formula,Stevens formula,Rule formula and Macisaac formula were compared with the isotopic GFR（iGFR） by paired t test,and bias,15%,30%,50% coincidences were analyzed.Results PETIA and PENIA had good correlation（r=0.986）,the bias at medical decision level was acceptable.The 99mTc-DTPA clearance was（96.42±28.93） mL·min-1·（1.73m2）-1,and the median level of Cystatin C was 0.85 mg/L（0.46-4.32 mg/L）.eGFR calculated by all the Cys C-based formulas had correlation with iGFR.The eGFR calculated by Rule formula and Macisaac formula had smaller bias with iGFR than that calculated by Grubb formula and Stevens formula,and the 15%,30% and 50% coincidences were different between the 4 formulas.When iGFR≥90 mL·min-1·（1.73m2）-1,the 15% coincidence for Macisaac formula reached 65%.Conclusions The four Cys C-based formulas have different results when used for calculating eGFR in type 2 diabetic patients.All the factors,including ethnicity,age and kind of disease should be considered for selecting the appropriate formula to calculate the eGFR.

关 键 词：2型糖尿病 半胱氨酸蛋白酶抑制素C 肾小球滤过率 

分 类 号：R335.9[医药卫生—人体生理学]