实验与检验医学
實驗與檢驗醫學
실험여검험의학
EXPERIMENTAL AND LABORATORY MEDICINE
2014年
5期
520-522,548
,共4页
吕赛平%徐炎良%徐国辉%蒋春灵%刘琴%邹学森
呂賽平%徐炎良%徐國輝%蔣春靈%劉琴%鄒學森
려새평%서염량%서국휘%장춘령%류금%추학삼
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
胱抑素C%改良sMDRD公式%估算腎小毬濾過率%噁性腫瘤%化療%腎功能損傷
광억소C%개량sMDRD공식%고산신소구려과솔%악성종류%화료%신공능손상
Cystatin C%Modified sMDRD formula%Estimated glomerular filtration rate%Malignant tumor%Chemotherapy%Renal damage
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。
目的：探討血清胱抑素C(SCys C)與改良sMDRD公式診斷噁性腫瘤化療患者早期腎功能損傷的臨床價值。方法根據《中華內科雜誌》編委會腎病專業組製定的慢性腎功能不全代償期診斷標準將2014年2月至2014年6月江西省腫瘤醫院收治的283例噁性腫瘤化療患者分為早期腎功能損傷組(141例)與腎功能正常組(142例)，所有患者均接受SCys C檢測，其方法為免疫比濁法，同時採用改良sMDRD公式計算其估算腎小毬濾過率(eGFR)。結果早期腎功能損傷組SCys C顯著高于腎功能正常組(P＜0.01)，改良sMDRD公式eGFR顯著低于腎功能正常組(P＜0.01)。 SCys C診斷噁性腫瘤化療患者早期腎功能損傷的ROC麯線下麵積(AUC)為0.861(95%CI，0.818~0.904)，最佳診斷閾值為1.28mg/L，其對應的靈敏度(SEN)、特異度(SPE)分彆為63.83%、90.14%。改良sMDRD公式eGFR診斷噁性腫瘤化療患者早期腎功能損傷的AUC為0.992(95%CI，0.985~0.998)，最佳診斷閾值為97.1 ml/min/1.73m2，其對應的SEN、SPE分彆為97.16%、95.07%。改良sMDRD公式的AUC顯著大于SCys C(P＜0.01)。結論改良sMDRD公式對噁性腫瘤化療患者早期腎功能損傷的診斷價值優于SCys C，但是由于改良sMDRD公式臨床應用還不是很廣汎，因此其性能有待進一步研究。
목적：탐토혈청광억소C(SCys C)여개량sMDRD공식진단악성종류화료환자조기신공능손상적림상개치。방법근거《중화내과잡지》편위회신병전업조제정적만성신공능불전대상기진단표준장2014년2월지2014년6월강서성종류의원수치적283례악성종류화료환자분위조기신공능손상조(141례)여신공능정상조(142례)，소유환자균접수SCys C검측，기방법위면역비탁법，동시채용개량sMDRD공식계산기고산신소구려과솔(eGFR)。결과조기신공능손상조SCys C현저고우신공능정상조(P＜0.01)，개량sMDRD공식eGFR현저저우신공능정상조(P＜0.01)。 SCys C진단악성종류화료환자조기신공능손상적ROC곡선하면적(AUC)위0.861(95%CI，0.818~0.904)，최가진단역치위1.28mg/L，기대응적령민도(SEN)、특이도(SPE)분별위63.83%、90.14%。개량sMDRD공식eGFR진단악성종류화료환자조기신공능손상적AUC위0.992(95%CI，0.985~0.998)，최가진단역치위97.1 ml/min/1.73m2，기대응적SEN、SPE분별위97.16%、95.07%。개량sMDRD공식적AUC현저대우SCys C(P＜0.01)。결론개량sMDRD공식대악성종류화료환자조기신공능손상적진단개치우우SCys C，단시유우개량sMDRD공식림상응용환불시흔엄범，인차기성능유대진일보연구。
Objective To investigate the clinical value of serum Cystatin C(SCys C) and modified sMDRD formula in the di-agnosis of early-stage renal damage in patients with malignant tumors after chemotherapy. Methods A total of 283 cases of pa-tients 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 pa-tients with malignant tumors after chemotherapy, the modified sMDRD formula has better value than SCys C, but the clinical appli-cation of modified sMDRD formula is not very extensive, so further studies are required to determine its performance.
