目的：探讨不同肾小球滤过率（GFR）评估方程在慢性肾脏病（CKD）各期的一致性和适用性，以及血清Cys C值对预测GFR的价值。方法：选取CKD住院患者160例，检测患者血清中的肌酐和Cys C水平。分别通过CKD- EPI Cr （2009），CKD- EPI Cys C （2012），CKD- EPI Cr- Cys C （2012）和简化MDRD方程计算预测GFR （eGFR）值。根据美国K/DOQI指南，以简化MDRD方程的eGFR值为标准将所有患者分为CKDⅠ期、Ⅱ期、Ⅲ期和Ⅳ-Ⅴ期等4个组，并分别比较各组中各公式所得eGFR的相关性和均值的差异。结果：CKDⅠ期的CKD- EPI Cr方程与CKD- EPI Cys C方程、CKDⅡ期的简化MDRD与CKD- EPI Cys C方程所得eGFR无显著相关性（值均>0.05）；其余任意两个方程、在任意分组所得eGFR均显著正相关（值均<0.05）。其中，CKD- EPI Cr与简化MDRD方程、CKD- EPI Cys C与CKD- EPI Cr- Cys C方程在各组均具有较高的相关性（=0.607-0.983，值均<0.001）。而在CKDⅠ期，CKD- EPI Cr与CKD- EPI Cr- Cys C方程、简化MDRD与CKD- EPI Cys C方程、简化MDRD与CKD- EPI Cr- Cys C方程所得eGFR相关性均较低（值均<0.5，值均<0.05）。在CKDⅡ期，CKD- EPI Cr方程与CKD- EPI Cys C方程所得eGFR相关性较低（=0.432，=0.011）。分别将各组中不同评估方程所得eGFR两两进行配对样本的Wilcoxon符号秩检验，在CKDⅠ-Ⅲ期三组，各评估方程所得eGFR均存在显著差异（值均<0.01）；其中，CKD- EPI Cys C方程所得eGFR最低（值均<0.01），CKD- EPI Cr- Cys C方程次之（值均<0.01），CKD- EPI Cr和简化MDRD方程显著高于CKD- EPI Cys C和CKD- EPI Cr- Cys C方程（值均<0.01）。在CKD Ⅳ-Ⅴ期组， CKD- EPI Cys C方程所得eGFR显著高于另外三个公式（值均<0.001），尽管该组中各方程所得eGFR中位数差值均小于5 ml/（min.1.73㎡）。结论：在CKDⅠ-Ⅲ期，血清Cys C值对GFR的预测有重要价值，引入血Cys C值的CKD- EPI Cys C和CKD- EPI Cr- Cys C方程更有利于CKD的早期诊断与筛查。在CKDⅣ-Ⅴ期，不同评估方程所得eGFR具有较高一致性。%Objective:We aim to investigate the applications of different glomerular filtration rate (GFR) evaluation equations in chronic kidney disease (CKD) and the value of serum Cystatin C (Cys C) for evaluating GFR. Methods: One hundred and sixty in- patients enrolled in this study were detected for serum creatinine and Cys C. CKD- EPI Cr equation (2009) , CKD- EPI Cys C equation ( 2012) , CKD- EPI Cr- Cys C equation ( 2012) and simplified MDRD equation were used for evaluating the eGFR of all the patients. According to American K/DOQI guidelines, all the patients were divided to CKD stageⅠ, CKD stage Ⅱ, CKD stage Ⅲ and CKD stage Ⅳ- Ⅴ groups, then the eGFR values from different evaluation equations were compared respectively in each group. Results:There were significant correlations between any two equations in each group ( <0.05) , except CKD- EPI Cr equation and CKD- EPI Cys C equation in CKD stageⅠgroup, simplified MDRD equation and CKD- EPI Cys C equation in CKD stageⅡgroup ( >0.05) . Of which, there were high correlations between CKD- EPI Cr equation and simplified MDRD e-quation、 CKD- EPI Cys C equation and CKD- EPI Cr- Cys C equation in each group (=0.607- 0.983, <0.001) . In comparison, in CKD stageⅠgroup, the correlations between CKD- EPI Cr equation and CKD- EPI Cr- Cys C equation, simplified MDRD equa-tion and CKD- EPI Cys C equation, simplified MDRD equation and CKD- EPI Cr- Cys C equation were low ( <0.5, <0.05) . In CKD stageⅡ group, the correlation between CKD- EPI Cr equation and CKD- EPI Cys C equation was also low ( =0.432, =0.011) . Paired- sample signed rank test was used respectively to compare eGFR values from different evaluation equations in each group. In groups of CKD stageⅠ- Ⅲ, there was significant difference between eGFR values from different equations ( <0.01) . There into, the eGFR values from CKD- EPI Cys C equation were the lowest ( <0.01) , the values from CKD- EPI Cr and sim-plified MDRD equations were significantly higher than that from CKD- EPI Cys C and CKD- EPI Cr- Cys C equations ( <0.01) .In CKD stageⅣ- Ⅴgroup, the eGFR values from CKD- EPI Cys C equation were statistically higher than those from three other e-quations ( <0.001) , despite all the median differences were less than 5 ml/(min.1.73㎡) . Conclusion:In CKD stageⅠ- Ⅲ, serum Cys C is valuable for evaluating GFR, CKD- EPI Cys C and CKD- EPI Cr- Cys C equations, which introduce serum Cys C, are more conducive to early diagnosis and screening of CKD. In CKD stage Ⅳ- Ⅴ, eGFR values from different equations are of high consistency.
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