血清半胱氨酸蛋白酶抑制剂C、肌酐评估慢性肾病患者肾小球滤过功能价值的Meta分析

目的评价血清半胱氨酸蛋白酶抑制剂C(Cys C)、肌酐(Cr)对慢性肾病肾小球滤过功能的诊断价值。方法检索1966年～2010年9月MEDLINE、EMbase、Cochrane图书馆等数据库,收集关于检测血清Cys C、Cr对肾小球滤过功能的诊断价值的相关研究文献并进行质量评价,采用Cochrane协作网提供的RevMan 4.2.7软件进行异质性分析,Meta-Disc软件进行Meta分析及绘制合并受试者工作特征(SROC)曲线。结果共检索到相关文献231篇,最终纳入14篇文献,研究实验对象2 169例。Meta分析结果显示,肾小球滤过率(GFR)以80～90 mL/min为诊断截点,Cys C诊断研究存在明显异质性[P=0.098、变异比率(I2)=34.7%、合并敏感度(SEN)=0.873、合并特异度(SPE)=0.791];Cr诊断研究无明显异质性(P=0.56、I2=0.0%、SEN=0.740、SPE=0.867)。5篇文献对GFR分期研究,合并GFR轻度减低(60～90 mL/min)组分析结果,Cys C、Cr均无明显异质性。Cys C:P=0.708、I2=0.0%、比值比(OR)=7.04[95%可信区间(CI):4.54～10.92];Cr:P=0.945、I2=0.0%、OR=9.40(95%CI:5.75～15.30)。Cys C对慢性肾病GFR轻度减低的诊断敏感度高于Cr、特异性低于Cr[Cys C:SEN=0.813,SPE=0.609、SROC曲线下面积(SAUC)=0.822 6;Cr:SEN=0.605、SPE=0.819、SAUC=0.826 3]。结论 Cys C、Cr与GFR有良好相关性。Cys C对早期慢性肾病患者GFR诊断敏感性高于Cr、特异性低于Cr。慢性肾病患者GFR分期研究不多,仍需要高质量的研究文献。

A Meta-analysis on the value of serum cystatin C and creatinine in evaluating glomerular filtration rate in patients with chronic kidney disease

Objective To evaluate the diagnostic value of serum cystatin C （Cys C ） and creatinine （Cr） in glomerular filtration rate （GFR） of chronic kidney disease patients. Methods MEDLINE, EMbase, the Cochrane Library and other databases （1966 to 2010 September） were searched for collecting studies which evaluated the diagnostic value of serum Cys C and Cr in evaluating GFR in patients with chronic kidney disease. The heterogeneity was tested by the Cochrane Collaboration＇s software RevMan 4.2.7. The summary receiver operating characteristic （SROC） curve and Meta-analysis were performed by Metadisc. Results A total of 231 relevant articles were searched, and 14 articles were included in the study. The study subjects were involved 2 169 patients. Meta-analysis showed that the cut- off value of GFR was 80-90mL/min, the Cys C heterogeneity was high [ P = 0. 098 ,I2 = 34.7% , summary sensitivity （SEN） =0. 873, summary specificity （SPE） =0. 791] , and Cr had no heterogeneity （P =0.56,I2 =0.0% ,SEN = 0. 740, SPE =0.867）. In 5 articles with various stages of GFR, Meta-analysis of GFR （60-90mL/min） group showed that Cys C and Cr had no heterogeneity { Cys C ： P = 0. 708,12 = 0.0%, odds ratio （OR） = 7.04 [ 95% confidence interval （CI） ： 4.54-10.92], SEN = 0. 813, SPE -- 0. 609, the area under the SROC curve （SAUC） = 0. 822 6 ; Cr ： P = 0. 945,12 =0.0% ,OR =9.40（95% CI： 5.75-15.30）, SEN =0.605 ,SPE =0. 819 ,SAUC =0.826 3 }. Conclusions There are significant correlations between Cys C, Cr and GFR. As for early chronic kidney disease, CysC has more sensitivity but less specificity than Cr for evaluation of GFR. Further high quality researches on various stages of GFR in chronic kidney disease patients are still required.