摘要
目的评价基于血清胱抑素C(Cys C)的估算肾小球滤过率(eGFR)公式在健康人群和慢性肾病(CKD)患者中的适用性。方法选取2 495例健康人和805例CKD患者作为研究对象,测定其血清Cys C和肌酐(Cr),使用改善全球肾脏病预后组织(KDIGO)慢性肾脏病评估与管理临床实践指南推荐的公式(2012CKD-EPIcr-cysc,2012CKD-EPIcysc)和笔者实验室建立的基于Cys C的公式(eGFRcysc)分别计算研究对象的eGFR。以KDIGO推荐的公式为参考,用偏倚、偏倚的四分位数间距(IQR)和P30评价eGFRcysc的性能。结果健康人群的Cys C和Cr的M(P25,P75)分别为0.76(0.67,0.86)mg/L和64.1(53.8,75.6)μmol/L。CKD患者的Cys C和Cr的M(P25,P75)分别为4.18(1.99,5.93)mg/L和385.4(152.1,704.5)μmol/L。在健康人群和CKD的1~4期患者中,eGFRcysc与2012CKD-EPIcr-cysc的偏倚均小于2012CKD-EPIcysc的偏倚。在所有研究对象中,IQR是较低的(2.0~13.3)。在健康人群和CKD的1~2期患者中,P30均达到90%以上。Bland-Altman分析结果显示,在所有研究对象中,偏倚的一致限在-30~30范围内,一致限内的比例均大于90%。在CKD分期方面,eGFRcysc与2012CKD-EPIcr-cysc具有中等的一致性(κ=0.487)。结论在评价健康人群、1期CKD患者和2期CKD患者的GFR时,eGFRcysc与2012CKD-EPIcr-cysc具有较好的一致性。在评价3~5期CKD患者的GFR时,与2012CKD-EPIcr-cysc比较,eGFRcysc会高估GFR。在1~3期CKD患者中,eGFRcysc与2012CKD-EPIcr-cysc具有较好的分期一致性,在4~5期CKD患者中,分期一致性较差。
Objective To evaluate the applicability of estimated glomerular filtration rate （eGFR） formula based on eystatin C （Cys C） in healthy population and chronic kidney disease （CKD） patieots, Methods The serum Cys C and creatinine （Cr） were measured in 2 495 healthy population and 805 CKD patients, The aGFR were calculated with two 2012 Chronic Kidney Disease Epidemiology Collaboration （CKD-EPI） equations （2012CKD-EPIcr-cysc and 2012CKD-EPIcysc） arid eGFReysc equation based on CysC, respectively. Taking 2012CKD-EPI equation as a reference, the performance of eGFRcyse was evaluated with bias, interquartile range （IQR） and P30. Results The median （P25,P75） of Cys C and Cr in healthy population were 0.76 （0.67,0.86） mg/L and 64.1 （53, 8,75.6） μmol/L,respectively. The median （P25 ,P75） of Cys C and Cr in CKD patients were 4. 18 （1.99,5.93） mg/L and 385.4 （152. 1,704.5） μmol/L, respectively. In healthy population and 1 ~ 4 phase of CKD patients,the bias of eGFRcysc arid 2012 CKD-EPIcr-cysc was less than that of 2012CKD-EPIcysc. Of all the subjects, IQR was lower （the lowest 2.0, the highest 13, 3）. p30 were roore than 90 % in healthy population and 1~ 2 phase of CKD patients. The results of Bland-Airman analysis showed that in all the subjects, the limit of the bias was within the range of -30 to 30, and the proportion within the agreement limit was more than 90%. In CKD staging, eGFRcysc and 2012 CKD-EPIcr-cysc had moderate consistency （kappa=0. 487）. Conelusion The eGFRcssc equation had good consistency with 2012CKD-EPIcr-cysc in evaluating the GFR of healthy population, 1 phase CKD patients and 2 phase CKD patients. In evalu- ating the GFR of 3 ~5 phase of CKD patients, eGFRcysc would overestimate GFR compared with 2012CKD-EPIcr-cysc. There was a better consistency between e GFRcysc and 2012CKD-EPfer-cysc in 1 ~ 3 phase of CKD patients, and was poor in the 4~5 phase CKD patients on the CKD staging.
作者
刘运双
张彬
张亚梅
罗立梅
吴泳桦
LIU Yun-shuang;ZHANG Bin;ZHANG Ya-mei;LUO Li-mei;WU Yong-hua(Department of Clinical Laboratory ,Mianyang Central Hospital ,Sichuan Mianyang 621000 ,China)
出处
《现代检验医学杂志》
CAS
2018年第3期54-59,64,共7页
Journal of Modern Laboratory Medicine
关键词
健康人群
慢性肾病患者
胱抑素C
肌酐
估算肾小球滤过率
healthy population
chronic kidney disease patients
cystatin C
creatinine
estimated glomerular filtration rate
