多种不同指标评估肾小球滤过率价值比较

摘要

Objective To study the value of cystatin C(CysC),serum creatinine(Scr),endogenous creatinine clearance rate (Ccr) for evaluation of the glomerular filtration rate (GFR). Methods A total of 146 participants,who were enrolled in the Daping Hospital for physical examination and hospitalization in Nephrology Department from January to August of 2012 ,were se-lected,including 40 cases in healthy control group and 106 cases in nephrosis group. Beckman DXC-800 full automatic biochemi-cal analyzer was adopted for the detection of CysC, Scr,and Ccr the participants in the two groups. The nephrotic patients were di vided into four groups[groupⅠ(with Ccr≥80 mL/min,n=36),groupⅡ(with Ccr 50-<80 mL/min,n=20),groupⅢ(with Ccr20-<50 mL/min,n=30)and groupⅣ(with Ccr<20 mL/min,n=20)] according to the levels of Ccr from high to low,to compare the sen-sibility and accuracy of different indicators for detection of renal function damage. The patients in groupⅠand the healthy control group were divided into different age groups and gender groups,to analyze whether or not the difference of Scr and CysC between the two groups existed. Results CysC increased with the decline of Ccr,and they were negative related(r=-0.973,P=0.000). CysC increased significantly when the Ccr was in 50-<80 mL/min,but the Scr was within normal range,which showed that the sensitivity of CysC was higher than that of Scr. There was no statistically significant difference on Scr and Cysc among different age groups in groupⅠand the healthy control group(P>0.05),and the difference of CysC between gender groups had no statistical significance(P>0.05),however,the Scr of the male was significantly higher than that of the female with statistically significant difference(P<0.01). The increase of Scr was not obvious with the decline of Ccr,moreover,the correlation of Scr and Ccr was low-er than that of CysC and Ccr. Conclusions Serum CysC,which is more sensitive than Scr and negatively related with Ccr,has higher accuracy for detection of abnormal renal function. CysC is independent of age and gender, its detection is better than Ccr.%目的：比较胱抑素C （CysC）、血清肌酐（Scr）和内生肌酐清除率（Ccr）作为肾小球滤过率评估标志的价值。方法选取2012年1~8月在第三军医大学大坪医院健康体检人群和肾内科住院肾病患者共146例，其中健康对照组40例，肾病组106例。采用Beckman DXC-800全自动生化分析仪检测两组受检者CysC、Scr和Ccr。根据Ccr由高到低将肾病患者组分为四组[Ⅰ组（Ccr≥80 mL/min）36例，Ⅱ组（Ccr 50~<80 mL/min）20例，Ⅲ组（Ccr 20~<50 mL/min）30例，Ⅳ组（Ccr<20 mL/min）20例]，比较各组间各指标检测肾功能损害的敏感性及准确性。将Ⅰ组及健康对照组患者分为不同年龄组及不同性别组，分析各组间的Scr和CysC有无差异。结果 CysC随着Ccr降低而升高，二者呈负相关（r=-0.973，P=0.000），Ccr在50～<80 mL/min时，CysC已显著升高，而Scr仍在正常值范围内，说明CysC敏感性较Scr高；Ⅰ组及健康对照组不同年龄组间患者中Scr与CysC比较，差异无统计学意义（P＞0.05），不同性别间CysC比较，差异无统计学意义（P＞0.05），而Scr则男性高于女性，差异有统计学意义（P＜0.01）。Scr随着Ccr降低升高不明显，且其与Ccr的相关性较CysC与Ccr的相关性低。结论 CysC检测肾功能异常的准确性较高，较Scr更加敏感，且与Ccr呈负相关。检测CysC较Ccr更好，不受年龄、性别的影响。