血清肌酐及cystatinc和尿白蛋白测定和报告中需要强调的问题.ppt

血清肌酐及CystatinC和尿白蛋白测定和报告中需要强调的问题 徐国宾北京大学第一医院检验科 临床检验测量结果的一致可比，对于循证医学和专业团体制定的指南中特定标志物诊断、治疗干预决定水平的有效应用具有重要的作用。 Outline 肾损害≥ 3个月，肾损害指肾脏结构或功能异常，伴/不伴GFR降低，表现为下列之一： 病理异常 有肾损害指标：主要指血或尿成分异常，或影像学检查异常 GFR 60ml/min/1.73m2 ≥ 3个月，有或无肾损害 New equations to estimate GFR in children with CKD GFR [ml/(min·1.73 m2)]=39.1[Height(m)/Scr (mg/dl)]0.516×[1.8/cystatin C (mg/L)]0.294[30/BUN (mg/dl)]0.169[1.099]male[Height(m)/1.4]0.188 J Am Soc Nephrol. 2009 Mar;20(3):629-37. Creatinine Standardization Improve the precision of creatinine methods to meet the total error goal for serum creatinine measurement described in the paper published in Clinical Chemistry 2006;52(1):5-18. –Imprecision: Standard Deviation 0.08 mg/dL (7.1 μmol/L) –Bias to IDMS reference method: Bias 0.05 mg/dL (4.4 μmol/L) 常规系统血肌酐检测真实度调查 实验材料： NIST SRM967 两水平 冰冻人血清 具互通性 实验方法： 实验前，对仪器进行清洗保养和校准，精密度应达到操作手册中的要求； NIST SRM967于室温复融30min，颠倒混匀，每台仪器测量两次，取平均值参与计算。 Outline First discovered in 1961 as an alkaline protein in normal cerebrospinal fluid (CSF) Amino acid sequence was determined in 1981 Cysteine protease inhibitor belonging to the human cystatin family The distribution in body fluids of the different cystatins is remarkably different Blood plasma: 0.96 mg/L CSF: 5.8 mg/L (3.2 – 12.5) Urine: 0.095 mg/L (0.033 – 0.29) Saliva : 1.8 mg/L Seminal plasma:51.0mg/L Amniotic fluid: 1.0 mg/L Tears : 2.4 mg/L Milk : 3.4 mg/L Clinical application of Cystatin C Reference Ranges Children/Infants Adults Marker for Glomerular Filtration Rate (GFR) Estimation of GFR Acute Kidney Injury Kidney Transplants Cancer Cystatin C and Creatinine in relation to age in a population of 258 children 1-60岁之间水平恒定,受肌肉量影响小 在儿童和老年人群中应用较Scr更有特色 分布 参考范围 Reference Intervals Individuals 1-60 years: 0.5-1.1 mg/L Individuals 60 years: 0.6-1.4 mg/L (Represent 99% of the population) ROC曲线分析 Estimation of GFR Clinicians need fast estimate of renal