血清胱抑素C评估慢性肾脏病患者肾小球滤过率的应用研究  

The evaluation of gluomerular filtration rate in chronic kidney disease patients based on serum CysC

作　　者：刘红春[1] 苏利沙[1] 赵占正[2] 韩星敏[3] 李彦鹏[3] 刘栋[2] 张根豪[1] 张俊华[1] 

机构地区：[1]郑州大学第一附属医院检验科,450052 [2]郑州大学第一附属医院肾内科,450052 [3]郑州大学第一附属医院核医学科,450052

出　　处：《中华检验医学杂志》2014年第3期184-188,共5页Chinese Journal of Laboratory Medicine

基　　金：河南省卫生厅科技攻关项目资助课题（2011020036）

摘　　要：目的 比较血清胱抑素C及基于胱抑素C的几种肾小球滤过率评估方程在评估慢性肾脏病患者肾功能方面的应用价值.方法 采用实验应用研究方法,选取2010年10月至2011年10月郑州大学第一附属医院肾病科住院的慢性肾脏病（CKD）患者304例,其中男162例,女142例,年龄14 ～ 80岁.以双血浆法99mTc-DTPA血浆清除率测定肾小球滤过率（GFR）作为参考标准（sGFR）,将简化MDRD（GFR1）方程、CKD-EPI胱抑素C方程（GFR2）和CKD-EPI肌酐-胱抑素C方程（GFR3）计算的GFR与sGFR做比较,Spearman相关性分析和Bland-Altman一致性分析评价其相关性并用受试者工作特征（ROC）曲线评价各计算方程在CKD分期中的诊断价值.结果 3种肾小球滤过率计算方程计算结果和参考方法所得结果具有显著相关性（相关系数r分别为0.690、0.738、0.724,P均＜0.05）,但三者在不同GFR阶段评估GFR时同sGFR比较存在一定偏差：当sGFR＜15 ml/（min·1.73 m2）,即处于CKD5阶段时,GFR2 12.32（10.07 ～ 19.80）和GFR3 10.97（8.36 ～17.98）均显著低于sGFR 8.26（3.59 ～ 12.67）,Z=-3.959,P＜0.001; Z=-2.450,P=0.014.当GFR分别处于CKD2[GFR为60 ～ 89 ml/（min·1.73 m2）]和CKD4[GFR为15～29 ml/（min· 1.73m2）]阶段内时,GFR1显著高于sGFR（t=-2.705,P=0.027;Z=-2.510,P=0.01）,而当GFR分别处于CKD1 GFR≥90 ml/（min·1.73 m2）]和CKD3[GFR为30～59 ml/（min· 1.73 m2）]阶段内时,GFR2显著低于sGFR（t=4.270,P=0.004;t =2.762,P =0.011）;以GFRs为标准对CKD进行分期时,GFR1、GFR2、GFR3方程ROC曲线下面积分别为0.906、0.896和0.915.结论 3种肾小球滤过率评估方程在评估CKD患者肾功能方面都具有一定的诊断价值,但也存在着一定的偏差.综合分析,CKD-EPI肌酐-胱抑素C方程在CKD不同阶段内的计算结果较为准确,对CKD患者CKD分期诊断更为准确,在评估肾功能时联合分析血肌酐和血清胱抑素C可减少判断误差.Objective To evaluate the applicability of several formulas for gluomerular filtoation rate （GFR） evaluation based on serum CystatinC （CysC） in patients with chronic kidney disease （CKD）.Methods According to the method of laboratory appliance reseach,three hundred and four hospitalized CKD patients（162 males,142 females,aged from 14-year-old to 80-year-old） in the First Affiliated Hospital of Zhengzhou University hospital dating from October 2010 to October 20l 1 were selected.Twosample 99mTc-DTPA plasma clearance was determined as the standard GFR （sGFR） and the GFR based on simplized MDRD（GFR1） fomula,CKD-EPI CysC （GFR2） and CKD-EPI Cr-CysC fontula （GFR3）.The results were compared with sGFR respectively.In addition,their correlation and the clinical significance were observed with Spearman correlation analysis,Bland-Altman agreement analysis and receiver operator characteristic（ROC） curve respectively.Results The correlation between the result of each GFR formula and sGFR was significant （r =0.690,0.738,0.724,P 〈 0.05）,but some deviation existed when the estimated results were compared with sGFR in different CKD stages.When sGFR 〈 15 ml/（min · 1.73 m2） （namely in CKD5）,GFR2[12.32（10.07-19.80）] and GFR3[10.97（8.36-17.98）] were significantly lower than that of sGFR [8.26 （3.59-12.67）,Z =-3.959,P 〈 0.001 ; Z =-2.450,P =0.014],while as GFR in CKDstage2 [GFR：60-89 ml/（min· 1.73 m2）] and stage4[GFR：15-29 ml/（min· 1.73 m2）],GFR1 was significantly lower than that of sGFR （t =-2.705,P =0.027 ; Z =-2.510,P =0.01）.Furthermore,when GFR was in CKD stage 1 [GFR ≥ 90 ml/（min · 1.73 m2）] and stage3 [GFR：30-59 ml/（min · 1.73 m2）],GFR2 was significantly lower than that of sGFR （t =4.270,P =0.004 ; t =2.762,P =0.011）.In addition,when GFRs was applied as the standard diagnosis of CKD stage,the area under ROC of GFR1,GFR2 and GFR2 was 0.906,0.896 and 0.915 respectively.Conclusions The three GFR formulas are of diagnostic value in

关 键 词：肾功能不全 慢性 肾小球滤过率 胱抑素C 

分 类 号：R692[医药卫生—泌尿科学]