血清胱抑素C与改良sMDRD公式诊断恶性肿瘤化疗患者早期肾功能损伤的临床价值  

Clinical value of serum Cys C and modified sMDRD formula in the diagnosis of early-stage renal damage in patients with malignant tumors after chemotherapy

作　　者：吕赛平[1] 徐炎良[1] 徐国辉[1] 蒋春灵[1] 刘琴[1] 邹学森[1] 

机构地区：[1]江西省肿瘤医院,江西南昌330029

出　　处：《实验与检验医学》2014年第5期520-522,548,共4页Experimental and Laboratory Medicine

基　　金：江西省卫生厅课题(编号:20141124)

摘　　要：目的探讨血清胱抑素C（SCys C）与改良sMDRD公式诊断恶性肿瘤化疗患者早期肾功能损伤的临床价值。方法根据《中华内科杂志》编委会肾病专业组制定的慢性肾功能不全代偿期诊断标准将2014年2月至2014年6月江西省肿瘤医院收治的283例恶性肿瘤化疗患者分为早期肾功能损伤组（141例）与肾功能正常组（142例）,所有患者均接受SCys C检测,其方法为免疫比浊法,同时采用改良sMDRD公式计算其估算肾小球滤过率（eGFR）。结果早期肾功能损伤组SCys C显著高于肾功能正常组（P〈0.01）,改良sMDRD公式eGFR显著低于肾功能正常组（P〈0.01）。SCys C诊断恶性肿瘤化疗患者早期肾功能损伤的ROC曲线下面积（AUC）为0.861（95%CI,0.818-0.904）,最佳诊断阈值为1.28mg/L,其对应的灵敏度（SEN）、特异度（SPE）分别为63.83%、90.14%。改良sMDRD公式eGFR诊断恶性肿瘤化疗患者早期肾功能损伤的AUC为0.992（95%CI,0.985-0.998）,最佳诊断阈值为97.1 ml/min/1.73m2,其对应的SEN、SPE分别为97.16%、95.07%。改良sMDRD公式的AUC显著大于SCys C（P〈0.01）。结论改良sMDRD公式对恶性肿瘤化疗患者早期肾功能损伤的诊断价值优于SCys C,但是由于改良sMDRD公式临床应用还不是很广泛,因此其性能有待进一步研究。Objective To investigate the clinical value of serum Cystatin C（SCys C） and modified sMDRD formula in the diagnosis of early-stage renal damage in patients with malignant tumors after chemotherapy. Methods A total of 283 cases of patients with malignant tumors who received chemotherapy admitted into the Jiangxi Provincial Tumor Hospital from February 2014 to June 2014 were divided into early-stage renal damage group（141 cases） and normal renal function group（142 cases） according to the diagnostic criteria for compensatory stage of chronic renal insufficiency issued by nephropathy study group, editorial board of Chinese Journal of Internal Medicine. The SCys C was detected by immune turbidimetric assay in all patients, and the estimated glomerular filtration rate（eGFR） was calculated by modified sMDRD formula. Results The level of SCys C in early-stage renal damage group was significantly higher than that in normal renal function group（P〈0.01）, while the eGFR calculated by modified sMDRD formula was significantly lower than that in normal renal function group（P〈0.01）. The area under the ROC curve（AUC） for SCys C was 0.861（95%CI, 0.818-0.904）, and the best cut-off value was 1.28mg/L, the corresponding sensitivity and specificity were 63.83%, 90.14% respectively. The AUC for eGFR calculated by modified sMDRD formula was 0.992（95%CI,0.985-0.998）,and the best cut-off value was 97.1 ml/min/1.73m2, which had a SEN of 97.16%, SPE of 95.07%. The AUC for modified sMDRD formula was significantly larger than that for SCys C（P〈0.01）. Conclusion For the diagnosis of early-stage renal damage in patients with malignant tumors after chemotherapy, the modified sMDRD formula has better value than SCys C, but the clinical application of modified sMDRD formula is not very extensive, so further studies are required to determine its performance.

关 键 词：胱抑素C 改良sMDRD公式 估算肾小球滤过率 恶性肿瘤 化疗 肾功能损伤 

分 类 号：R446.112[医药卫生—诊断学] R730.53[医药卫生—临床医学]