基于血清胱抑素C的肾功能估算公式在肾功能评价中的价值  

Diagnostic value of cystatin C-based prediction equations for glomerular iltration rate estimation

作　　者：马宏星[1] 陈淑珍[1] 陈雪民[1] 

机构地区：[1]同济大学附属同济医院核医学科,上海200065

出　　处：《中华核医学与分子影像杂志》2014年第3期204-207,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的以GFR为标准，评价基于血清胱抑素C的多种肾功能估算公式的价值。方法回顾性研究198例行^99Tc^m-DTPAGFR测定并有血清胱抑素C、SCr测定结果的住院患者（男85例，女113例，平均年龄66．5岁）。GFR测定采用Gates法，血清胱抑素C采用颗粒增强透射免疫比浊法测定，SCr采用苦味酸法测定。用8种不同的公式（6种基于血清胱抑素C，2种基于SCr）估算GFR，并与Gates法测得的GFR（实测值）比较（单因素方差分析和最小显著差异t检验）。根据实测GFR，将患者分为肾功能正常、轻度受损、中度受损和重度受损组。各公式法对肾功能损伤的诊断效能比较采用妒检验。结果198例中肾功能受损159例（轻度78例，中度58例，重度23例）。在肾功能中、重度受损者中，GFR[经体表面积（1．73m^-2）标准化，ml·min^-1]的Tan公式计算值与实测值差异均无统计学意义[重度：（20．7±7．4）ml·min^-1与（19．9±8．2）ml·min^-1，F=6．75，t〈1．05；中度：（42．1±14．4）ml·min^-1与（46．8±9．2）ml·min^-1，F=10．49，t〈1．63；均P〉0．05），且其与实测值偏差最小[重度：（12．3±7．0）％；中度：（17．9±13．0）％]。肾功能轻度受损及肾功能正常者中，Tan公式无明显优势。基于SCr的简化肾脏病膳食改良研究（MDRD）公式和慢性肾脏病流行病学合作研究（CKD—EPI）公式诊断肾功能受损的灵敏度分别为66．0％（105／159）和70．4％（112／159）、准确性分别为71．2％（141／198）和73．7％（146／198），低于基于血清胱抑素C的肾功能公式灵敏度[≥83．6％（133／159）]和准确性[≥79．3％（157／198）]x^2≥23．50，均P〈0．01。对于慢性肾病（中、重度肾损伤，81例）的诊断，基于血清胱抑素C的肾功能公式灵敏度[≥86．4％（70／81）]高于简化MDRD公式和CKD—EPI公式[分别为76．5％（62／81）和79．0％（64／81）Objective To investigate whether cystatin C-based prediction equations for GFR estimation are superior to SCr-based prediction equations. Methods One hundred and ninety-eight consecutive patients （85 males, 113 females, average age 66.5 years） who underwent GFR measurement with ^99Tc^m- DTPA and serum cystatin C and SCr tests were included in this retrospective study. GFR, serum cystatin C and SCr concentrations were determined by the Gates method （measured GFR）, the particle-enhanced turbidimetr/c immunoassay, and the Jaffe method, respectively. Eight different equations （6 equations based on the serum cystatin C, and the other 2 based on SCr） were used to estimate GFR values, and the results were compared with that of the Gates method. Patients were divided into different groups according to the measured GFR （normalized to body surface area, 1.73 m^-2） ： normal renal function, mild, moderate or severe renal impairment groups. One-way analysis of variance and the least significant difference t test were used to compare the estimated GFR, and x^2 test was used to compare the diagnostic efficiencies of different GFR estimation equations. Results Among 198 patients, 159 cases were with renal impairment （78 mild, 58 moderate, 23 severe）, and the other 39 cases were with normal renal function. For patients with moderate or severe renal impairment, the estimated GFR calculated by the Tan formula was not different from the measured GFR （severe： （20.7±7.4） ml·min^-1 vs （19.9±8.2） ml· min^-1; F=6.75, t〈1.05; moderate： （42.1±14.4） ml · min^-1 vs （46.8±9.2） ml · min^-1 ; F= 10.49, t〈1.63; both P〉0.05）, and it had the least error compared with the measured GFR （ severe ： （ 12.3 ±7.0） % ; moderate ： （ 17.9± 13.0） % ）. For the patients with mild renal impairment and normal renal function, the estimated GFR calculated by the Tan formula was not valuable. For the diagnosis of renal impairment, the sensitivity and accuracy of the modification of diet i

关 键 词：肾小球滤过率 放射性核素显像 DTPA 西司他汀类 方法 

分 类 号：R692[医药卫生—泌尿科学]