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
기우혈청광억소C적신공능고산공식재신공능평개중적개치
Diagnostic value of cystatin C-based prediction equations for glomerular filtration rate estimation
  • 万方数据
    中华核医学与分子影像杂志 중화핵의학여분자영상잡지
    Chinese Journal of Nuclear Medicine and Molecular Imaging
    2014年 3期 204-207 ,共4页

    马宏星%陈淑珍%陈雪民

    마굉성%진숙진%진설민

    肾小球滤过率%放射性核素显像%DTPA%西司他汀类%方法 腎小毬濾過率%放射性覈素顯像%DTPA%西司他汀類%方法
    신소구려과솔%방사성핵소현상%DTPA%서사타정류%방법
    Glomerular filtration rate%Radionuclide imaging%DTPA%Cystatins%Methods
    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99Tcm-DTPA GFR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x2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(1.73 m-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)nml·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)],≥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)],准确性[Tan公式,80.3％ (159/198)]略下降(x2≥56.42,均P＜0.05).结论 基于血清胱抑素C的Tan公式对肾功能中、重度受损(血清胱抑素C≥1.55 mg/L)的判断优于简化MDRD公式和CKD-EPI公式,但对肾功能轻度受损及肾功能正常者价值不大.
    목적 이GFR위표준,평개기우혈청광억소C적다충신공능고산공식적개치.방법 회고성연구198례행99Tcm-DTPA GFR측정병유혈청광억소C、SCr측정결과적주원환자(남85례,녀113례,평균년령66.5세).GFR측정채용Gates법,혈청광억소C채용과립증강투사면역비탁법측정,SCr채용고미산법측정.용8충불동적공식(6충기우혈청광억소C,2충기우SCr)고산GFR,병여Gates법측득적GFR(실측치)비교(단인소방차분석화최소현저차이t검험).근거실측GFR,장환자분위신공능정상、경도수손、중도수손화중도수손조.각공식법대신공능손상적진단효능비교채용x2검험.결과 198례중신공능수손159례(경도78례,중도58례,중도23례).재신공능중、중도수손자중,GFR[경체표면적(1.73 m-2)표준화,ml·min-1]적Tan공식계산치여실측치차이균무통계학의의[중도:(20.7±7.4) ml· min-1여(19.9±8.2)nml·min-1,F=6.75,t＜1.05;중도:(42.1±14.4) ml·min-1여(46.8±9.2) ml·min-1,F=10.49,t＜1.63;균P＞0.05),차기여실측치편차최소[중도:(12.3±7.0)％;중도:(17.9±13.0)％].신공능경도수손급신공능정상자중,Tan공식무명현우세.기우SCr적간화신장병선식개량연구(MDRD)공식화만성신장병류행병학합작연구(CKD-EPI)공식진단신공능수손적령민도분별위66.0％ (105/159)화70.4％ (112/159)、준학성분별위71.2％(141/198)화73.7％ (146/198),저우기우혈청광억소C적신공능공식령민도[≥83.6％(133/159)]화준학성[≥79.3％(157/198)],≥23.50,균P＜0.01.대우만성신병(중、중도신손상,81례)적진단,기우혈청광억소C적신공능공식령민도[≥86.4％(70/81)]고우간화MDRD공식화CKD-EPI공식[분별위76.5％ (62/81)화79.0％(64/81)],준학성[Tan공식,80.3％ (159/198)]략하강(x2≥56.42,균P＜0.05).결론 기우혈청광억소C적Tan공식대신공능중、중도수손(혈청광억소C≥1.55 mg/L)적판단우우간화MDRD공식화CKD-EPI공식,단대신공능경도수손급신공능정상자개치불대.
    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 99TcmDTPA 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 turbidimetric 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,andx2 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 in renal disease (MDRD) formula were 66.0％(105/159) and 71.2％(141/198),respectively,and those of the chronic kidney disease-epidemiology collaboration (CKD-EPI) formula were 70.4％ (112/ 159) and 73.7％(146/198),respectively.The sensitivities and accuracies of the cystatin C-based formulas (≥83.6％ (133/159) and ≥79.3％(157/198),respectively) were higher than those of MDRD formula and CKD-EPI formula (x2 ≥23.50,all P＜0.01).For the diagnosis of chronic kidney disease (including 81 patients with moderate and severe renal impairment),the sensitivities of cystatin C-based prediction equations (≥ 86.4％ (70/81)) were higher than those of the MDRD formula and the CKD-EPI formula (76.5％ (62/81),79.0％ (64/81)),but the accuracies were slightly lower (Tan formula:80.3％ (159/198),x2≥ 56.42,all P＜0.05).Conclusion The Tan formula may be more suitable for the GFR estimation than the MDRD formula and CKD-EPI formula in the patients with severe or moderate renal impairment (serum cystatin C≥ 1.55 mg/L),but it may not be reliable for the patients with mild renal impairment and normal renal function.
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