中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
CHINESE JOURNAL OF LABORATORY MEDICINE
2014年
3期
184-188
,共5页
刘红春%苏利沙%赵占正%韩星敏%李彦鹏%刘栋%张根豪%张俊华
劉紅春%囌利沙%趙佔正%韓星敏%李彥鵬%劉棟%張根豪%張俊華
류홍춘%소리사%조점정%한성민%리언붕%류동%장근호%장준화
肾功能不全,慢性%肾小球滤过率%胱抑素C
腎功能不全,慢性%腎小毬濾過率%胱抑素C
신공능불전,만성%신소구려과솔%광억소C
Renal insufficiency,chronic%Glomerular filtration rate%Cystatin C
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.
目的 比較血清胱抑素C及基于胱抑素C的幾種腎小毬濾過率評估方程在評估慢性腎髒病患者腎功能方麵的應用價值.方法 採用實驗應用研究方法,選取2010年10月至2011年10月鄭州大學第一附屬醫院腎病科住院的慢性腎髒病(CKD)患者304例,其中男162例,女142例,年齡14 ~ 80歲.以雙血漿法99mTc-DTPA血漿清除率測定腎小毬濾過率(GFR)作為參攷標準(sGFR),將簡化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)計算的GFR與sGFR做比較,Spearman相關性分析和Bland-Altman一緻性分析評價其相關性併用受試者工作特徵(ROC)麯線評價各計算方程在CKD分期中的診斷價值.結果 3種腎小毬濾過率計算方程計算結果和參攷方法所得結果具有顯著相關性(相關繫數r分彆為0.690、0.738、0.724,P均<0.05),但三者在不同GFR階段評估GFR時同sGFR比較存在一定偏差:噹sGFR<15 ml/(min·1.73 m2),即處于CKD5階段時,GFR2 12.32(10.07 ~ 19.80)和GFR3 10.97(8.36 ~17.98)均顯著低于sGFR 8.26(3.59 ~ 12.67),Z=-3.959,P<0.001; Z=-2.450,P=0.014.噹GFR分彆處于CKD2[GFR為60 ~ 89 ml/(min·1.73 m2)]和CKD4[GFR為15~29 ml/(min· 1.73m2)]階段內時,GFR1顯著高于sGFR(t=-2.705,P=0.027;Z=-2.510,P=0.01),而噹GFR分彆處于CKD1 GFR≥90 ml/(min·1.73 m2)]和CKD3[GFR為30~59 ml/(min· 1.73 m2)]階段內時,GFR2顯著低于sGFR(t=4.270,P=0.004;t =2.762,P =0.011);以GFRs為標準對CKD進行分期時,GFR1、GFR2、GFR3方程ROC麯線下麵積分彆為0.906、0.896和0.915.結論 3種腎小毬濾過率評估方程在評估CKD患者腎功能方麵都具有一定的診斷價值,但也存在著一定的偏差.綜閤分析,CKD-EPI肌酐-胱抑素C方程在CKD不同階段內的計算結果較為準確,對CKD患者CKD分期診斷更為準確,在評估腎功能時聯閤分析血肌酐和血清胱抑素C可減少判斷誤差.
목적 비교혈청광억소C급기우광억소C적궤충신소구려과솔평고방정재평고만성신장병환자신공능방면적응용개치.방법 채용실험응용연구방법,선취2010년10월지2011년10월정주대학제일부속의원신병과주원적만성신장병(CKD)환자304례,기중남162례,녀142례,년령14 ~ 80세.이쌍혈장법99mTc-DTPA혈장청제솔측정신소구려과솔(GFR)작위삼고표준(sGFR),장간화MDRD(GFR1)방정、CKD-EPI광억소C방정(GFR2)화CKD-EPI기항-광억소C방정(GFR3)계산적GFR여sGFR주비교,Spearman상관성분석화Bland-Altman일치성분석평개기상관성병용수시자공작특정(ROC)곡선평개각계산방정재CKD분기중적진단개치.결과 3충신소구려과솔계산방정계산결과화삼고방법소득결과구유현저상관성(상관계수r분별위0.690、0.738、0.724,P균<0.05),단삼자재불동GFR계단평고GFR시동sGFR비교존재일정편차:당sGFR<15 ml/(min·1.73 m2),즉처우CKD5계단시,GFR2 12.32(10.07 ~ 19.80)화GFR3 10.97(8.36 ~17.98)균현저저우sGFR 8.26(3.59 ~ 12.67),Z=-3.959,P<0.001; Z=-2.450,P=0.014.당GFR분별처우CKD2[GFR위60 ~ 89 ml/(min·1.73 m2)]화CKD4[GFR위15~29 ml/(min· 1.73m2)]계단내시,GFR1현저고우sGFR(t=-2.705,P=0.027;Z=-2.510,P=0.01),이당GFR분별처우CKD1 GFR≥90 ml/(min·1.73 m2)]화CKD3[GFR위30~59 ml/(min· 1.73 m2)]계단내시,GFR2현저저우sGFR(t=4.270,P=0.004;t =2.762,P =0.011);이GFRs위표준대CKD진행분기시,GFR1、GFR2、GFR3방정ROC곡선하면적분별위0.906、0.896화0.915.결론 3충신소구려과솔평고방정재평고CKD환자신공능방면도구유일정적진단개치,단야존재착일정적편차.종합분석,CKD-EPI기항-광억소C방정재CKD불동계단내적계산결과교위준학,대CKD환자CKD분기진단경위준학,재평고신공능시연합분석혈기항화혈청광억소C가감소판단오차.
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 evaluating renal function of CKD patients,but the deviation also exists.In comparision,the CKD-EPI Cr-CysC fomula (GFR3) was more accurate than others in different CKD stages with larger ROC area in diagnosing CKD stage and the error can be reduced by combining serum Cr and CysC when evaluating kidney function.