摘要
目的 系统评价反映肾小球滤过功能损伤的血清生化标志物肌酐 (creatinine ,Cr)的诊断效能。方法 计算机检索 1993～ 2 0 0 3年MEDLINE、EMBASE和中国生物医学文献数据库 (CBM ) ,按照文内所述的纳入标准共收集到关于肾小球滤过功能损伤的实验室研究指标的文献 34篇 ,利用SPSS、EXCEL统计软件以及Cochrane方法学协作组提供的RevMan软件进行统计分析。结果 肌酐的综合比数比 (OR)为 2 4 2 3,综合受试者工作曲线下面积为 0 871。根据不同诊断标准方法 (菊粉、铬 乙二胺四乙酸、锝 二乙烯三乙胺五乙酸、碘海醇和12 5I 碘他拉酸盐等 )进行分组分析 ,结果显示组间分析无显著性差异 (P =0 32 ) ;组内分析菊粉、铬 乙二胺四乙酸、锝 二乙烯三乙胺五乙酸、碘海醇无显著差异 (P值分别为 0 6 1,0 5 0 ,0 36 ,0 32 ) ,12 5I 碘他拉酸盐有显著性差异 (P =0 0 2 ) ;在肌酐不同测定方法诊断效能亚组分析中 ,苦味酸法有显著性差异 (P =0 0 3) ,酶法组内分析无显著性差异 (P =0 2 2 )。结论 肌酐对肾小球滤过功能损伤的诊断效能不高 ,建议仍采用酶法测定肌酐 ,在肌酐研究中宜选择菊粉或99mTc DTPA为其诊断参考标准 。
Objective To evaluate the diagnostic value of creatinine, as an indicator of glomerular filtration function injury.Methods MEDLINE, EMBASE and CBM-disc were searched from 1993 to 2003. Thirty four articles that described biomedical markers to indicate glomerular filtration function injury were selected according to specified inclusion criteria. These articles were evaluated systematically using SPSS, EXCEL, and RevMan software.”HZResults The odds ratios of creatinine was 24.23. Areas under summarized receiver operator characteristic curve were 0.871. Selected articles were divided to groups for analysis according to diagnostic standards, such as inulin, iohexol, 125 I-iothalamate, 51 Cr-EDTA, 99m Tc-DTPA and sodium thiosulfate. Inter-group analysis of creatinine was not statistically different (3=0.32). Intra-group analysis of inulin, 51 Cr-EDTA, 99m Tc-DTPA, and iohexol was not statistically different, 3 value were 0.61, 0.50, 0.36, 0.32, respectively. Intra-group analysis of 125 I-iothalamate was statistically different (P3=0.02). Selected articles were sub-grouped according to different analytic techniques of creatinine. Intra-group analysis by the Jaffe method was statistically different (3=0.03), intra-group analysis of enzymatic method was not statistically different (3=0.22). Conclusion The diagnostic value of creatinine was not qualified enough to indicate glomerular filtration function injury. Enzymatic methods are recommended to measure creatinine. Inulin or 51 Cr-EDTA is suggusted to measure glomerular filtration rate in investigation of creatinine,and feedforward cohort is recommended to apply.
出处
《中国循证医学杂志》
CSCD
2004年第11期752-758,共7页
Chinese Journal of Evidence-based Medicine
