Cystatin C在评价慢性肾病患者肾小球滤过功能中作用.docVIP

Cystatin C在评价慢性肾病患者肾小球滤过功能中作用 　【摘要】 目的： 比较血清半胱氨酸蛋白酶抑制剂C（Cystatin C）、肌酐（Scr）、肌酐清除率（Ccr）在慢性肾病（CKD）患者各期与估算的肾小球滤过率（eGFR）的符合率。方法： 血清Cystatin C采用免疫透射比浊法测定，Scr和尿肌酐采用酶法测定，基于Scr估算的eGFR采用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K/DOQI指南按eGFR分为5期。结果： 168例CKD患者各期Cystatin C,Scr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（Plt;0.05）。当eGFR≤29 ml/min时，Cystatin C,Scr,Ccr的异常率均为100%，Cystatin C,Scr平均水平是正常参考上限的3～5倍和4～6倍，Ccr下降4～7倍，三者呈平行性改变；在eGFR 30～59 ml/min组，Cystatin C,Scr,Ccr的平均水平分别为2.06 mg/L,131.2 μmol/L和45.6 ml/min，异常率分别为97%,80%和89%，三者之间异常率的差异无统计学意义（P＞0.05）；在eGFR 60～89 ml/min组，CystatinC,Ccr 异常率为87%和69%，Scr异常率为6.5%，三者之间异常率的差异具有统计学意义（Plt;0.05）；在eGFR≥90 ml/min组，Cystatin C,Ccr 异常率为60%和42%，Scr异常率为0。结论： eGFR＜60 ml/min时，其与Cystatin C,Scr,Ccr的总符合率高，基本可以诊断肾小球滤过功能中度下降；60 ml/min≤eGFR≤89 ml/min时，Cystatin C,Ccr可以检出2/3患者肾小球滤过率的异常，Cystatin C比Ccr更敏感，而Scr不能反应肾小球滤过功能的下降；当eGFR≥90 ml/min时，MDRD方程高估了实际GFR，对于老年CKD患者，MDRD方程不适用，需检测Cystatin C和Ccr以及时发现GFR的下降。 【关键词】 半胱氨酸蛋白酶抑制剂； 肌酐； 肌酐清除率； 肾病 　　［Abstract］ Objective: To compare the coincidence of Cystatin C, serum creatinine,creatinine clearance(Ccr) in each eGFR stage of chronic kidney disease(CKD) patients. Methods： Cystatin C was measured by turbidimetric method, Creatinine in serum and urine were determined by enzyme method, while eGFR was calculated using the abbreviated MDRD equation which was mainly based on the serum creatinine concentration. According to the American NKFK/DOQI guideline, all cases were grouped by eGFR into 5 stages. Results： In these 168 cases, as eGFR decreased gradually, the average levels of Cystatin C and creatinine increased, while Ccr decreased. The level of each items showed a statistic difference among each stage(Plt;0.05), in eGFR≤29 ml/min groups, the abnormal rate of Cystatin C, Scr, Ccr were all 100%, and the average levels of Cystatin C and Scr were 3～6 times and 4～5 times to the upper reference limit, while Ccr was 4～7 times to the lower reference limit; in eGFR 30～59 ml/min groups, the average levels of Cystatin C,