摘要
目的比较血清肌酐(Scr)、肌酐清除率(Ccr)、半胱氨酸蛋白酶抑制剂 C(Cystatin c)及估算的肾小球滤过率(eGFR)在慢性肾病(CKD)患者各期中的符合率。方法 Scr 和尿肌酐采用苦味酸动力学法测定,血清Cystatin c采用颗粒增强免疫散射比浊法测定,主要基于 Scr 估计的 eGFR采用简化的肾病膳食改良试验(MDRD)方程进行计算,CKD 患者根据1999年美国肾病基金会(NKF)公布的"改善肾病预后及生活质量的倡议"(Kidney Disease Outcome Quality Initiative,K/DOQI)所制定的指南,按照 eGFR 分为5期。结果 228例 CKD 患者,各期 Scr、Cystatin C 随 eGFR 的降低而逐渐升高,Ccr 随 eGFR 的降低而逐渐降低,三者在各期间水平的差异均有统计学意义(P<0.05)。当 eGFR≤29 ml/min 时,Scr、Ccr 及 Cystatin C 的异常率均为100%,Scr、Cystatin C 平均水平是正常参考值上限的4～6倍和3.5～5.5倍,Ccr 下降3.8～7.3倍,三者呈平行性改变;在 eGFR 30～59 ml/min 组,Scr、Ccr 和 Cystatin C 的平均水平分别为129.2 μmol/L、44.3 ml/min和2.16 mg/L,异常率分别为84%、91%和98%,三者间异常率的差异无统计学意义(P>0.05);在 eGFR 60～89 ml/min 组,血清肌酐的平均水平为83.3 μmoL/L,异常率仅为6.8%,对于 GFR 下降的检出不敏感,Ccr、Cystatin C 分别呈边缘性下降和上升,异常率为70%和86%,三者问异常率的差异有统计学意义(P<0.05);在 eGFR≥90 ml/min 组,血清肌酐的异常率为0,Ccr、Cystatin C 的异常率仍高达44%和59%。结论 eGFR<60ml/min时,与 Scr、Ccr 及 Cystatin C 的总符合率高,此时可以基本诊断肾小球滤过功能中度下降;60 ml/min≤eGFR≤89 ml/min 时,Scr 不能反映肾脏滤过功能的下降,但 Cystatin C 和 Ccr 至少能检出2/3患者 GFR 的异常,Cystatin C 较 Ccr 更敏感;在 eGFR≥90 ml/min 时,MDRD 方程高估了实际GFR,对于 Scr 水平正常,特别是老年 CKD 患者,MDRD 方程不适用,需联合检测 Ccr 和 Cystatin C,以及时发现 GFR 的下降。
Objective To compare the coherence of serum creatinine, creatinine clearance （Ccr）, Cystafin C, and estimated glomerular filtration rate （eGFR） in each stage of chronic kidney disease （CKD） patients. Methods Creatinine in serum and urine were determined by Jaffe method; serum Cystatin C was measured by particle enhanced turbidimetric method, while eGFR was calculated using the abbreviated Modification of Diet in Renal Disease （MDRD） equation which was mainly based on the serum creatinine concentration. According to the American national kidney foundation-Kidney Disease Outcome Quality Initiative （NKF-K/DOQI） guideline, all cases were grouped by eGFR into 5 stages. Results In these 228 cases, as eGFR decreased gradually, the average levels of creatinine and Cystatin C increased, while Ccr decreased. The level of each items showed a statistic difference among each stage （ P 〈 0. 05 ） ; in eGFR 29 mL/min groups, the abnormal rates of Scr, Ccr and Cystatin C were all 100 % , and the average levels of Scr and Cystatin C were 4-6 times and 3.5-5.5 times to the upper reference limit, while Ccr was 3.8-7.3 times to the lower reference limit; in eGFR 30-59 ml/min group, the average levels of creatinine, Ccr and Cystatin C were 129. 2 μmoL/L,4d. 3 ml/min and 2. 16 mg/L,and the abnormal rate were 84%, 91% and 98% respectively, no statistic difference was observed among the three rates （ P 〉 0. 05 ） ; in eGFR 60-89 ml/min group, the average level of creatinine was 83.3 μmol/L, the abnormal rate was only 6. 8% ,it was not a sensitive marker to detect the slightly damaged GFR, the levels of Ccr and Cystatin C showed a marginal decrease and increase, with an abnormal rates of 70% and 86%, there was a statistic difference among the three abnormal rates （ P 〈 0. 05 ） ; when eGFR ≥ 90 ml/min, the abnormal rate of creatinine was 0, while the abnormal rates of Ccr and Cystatin C still highly reached to 44% and 59%, respectively. Conclusions when eGFR 〈 60 ml/min,it showed a good coherence with Scr, Ccr and Cystatin C, at this time, a conclusion could be drown that glomeruler filtration function had decreased moderately; when 60 ml/min≤eGFR≤89 ml/min, Scr could not reflect the damage on GFR, but Cystatin C and Ccr could at least select out 2/3 patients with abnormal GFR, and Cystatin C was more sensitive than Ccr; when eGFR≥90 ml/min, MDRD equation overestimated the real GFR, so it was not fit for patients with a normal Set level, especially to the elder CKD patients, for these patients, it was requested to check Ccr and Cystatin C to find out GFR damage timely.
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2007年第4期415-418,共4页
Chinese Journal of Laboratory Medicine
关键词
半胱氨酸蛋白酶抑制剂
肾病
肌酐
肌酐清除率
Cysteine proteinase inhibitors
Nephrosis
Creatinine
Creatinine clearance
