240例肾脏疾病患者血清胱抑素C的变化及临床相关研究

我们检测240例肾脏疾病患者血清胱抑素C(Cystatin C)浓度,试图发现血清Cystatin C浓度与肾小球滤过率之间的关系,且与血尿素氮、血肌酐、内生肌酐清除率对照观察,探讨血清 Cystatin C浓度变化对判断肾小球滤过功能是否受损及受损程度的应用价值,且与临床相关性作一研究.     

缩孔综合征的研究进展

缩孔综合征(shrunken pore syndrome,SPS)是指在排除肾外因素影响血浆胱抑素C与肌酐的前提下,基于血浆胱抑素C估算的肾小球滤过率(eGFRcystatin C)显著低于基于肌酐估算的肾小球滤过率(eGFRcreatinine)的一种病理生理状态.研究表明,SPS患者预后不良,SPS患者心血管疾病发...     

海昆肾喜胶囊对慢性肾脏病患者血清胱抑素C的影响

目的 观察海昆肾喜胶囊对慢性肾脏病患者血清胱抑素C的影响.方法 20例明确诊断慢性肾脏病患者,在基础治疗上给予海昆肾喜胶囊每天6粒口服,于治疗前和治疗后8周分别检测血清胱抑素C、尿素氮、肌酐的变化.结果 海昆肾喜胶囊可明显降低慢性肾脏病患者的血清胱抑素C水平(P < 0.05);治疗前、后血清胱抑素C、血肌酐比较差异具有统计学意义(P < 0.05).结论 海昆肾喜胶囊可改善早期慢性肾脏病患者的肾功能,早期应用海昆肾喜胶囊有利于延缓慢性肾脏病的进展,具有一定临床意义.     

胱抑素C较肌酐更能决定肾功能相关的风险

在血肌酐的基础上增加胱抑素C可以准确地评估肾小球的滤过率（ eGFR）,但是这种方法在不同人群中对慢性肾脏病的检测、分期、危险分层有何影响尚不清楚。     

评价肾功能损害患者中血清胱抑素C测定的临床价值

近年来,随着肾脏疾病实验诊断技术的发展,人们逐渐认识到胱抑素C（cystatin C）是评价肾功能损害的灵敏标记物之一,可以有助于提高慢性肾脏病的早期诊断。但是Cystatin C与肾小球滤过率（GFR）之间的关系尚未明确,由此,我们检测了162例肾脏病患者血清Cystatin C浓度,     

海昆肾喜胶囊对慢性肾脏病患者血清胱抑素C的影响

目的 观察海昆肾喜胶囊对慢性肾脏病患者血清胱抑素C的影响.方法 20例明确诊断慢性肾脏病患者,在基础治疗上给予海昆肾喜胶囊每天6粒口服,于治疗前和治疗后8周分别检测血清胱抑素C、尿素氮、肌酐的变化.结果 海昆肾喜胶囊可明显降低慢性肾脏病患者的血清胱抑素C水平(P < 0.05);治疗前、后血清胱抑素C、血肌酐比较差异具有统计学意义(P < 0.05).结论 海昆肾喜胶囊可改善早期慢性肾脏病患者的肾功能,早期应用海昆肾喜胶囊有利于延缓慢性肾脏病的进展,具有一定临床意义.     

海昆肾喜胶囊对慢性肾脏病患者血清胱抑素C的影响

目的 观察海昆肾喜胶囊对慢性肾脏病患者血清胱抑素C的影响.方法 20例明确诊断慢性肾脏病患者,在基础治疗上给予海昆肾喜胶囊每天6粒口服,于治疗前和治疗后8周分别检测血清胱抑素C、尿素氮、肌酐的变化.结果 海昆肾喜胶囊可明显降低慢性肾脏病患者的血清胱抑素C水平(P < 0.05);治疗前、后血清胱抑素C、血肌酐比较差异具有统计学意义(P < 0.05).结论 海昆肾喜胶囊可改善早期慢性肾脏病患者的肾功能,早期应用海昆肾喜胶囊有利于延缓慢性肾脏病的进展,具有一定临床意义.     

血清胱抑素C、血清肌酐和尿β2-微球蛋白检测对高尿酸血症肾损害早期诊断的意义

目的探讨高尿酸血症肾损害患者中血清胱抑素C、血清肌酐及尿β2-微球蛋白的检测对评价高尿酸血症早期肾损害的临床价值。方法选取符合原发性高尿酸血症诊断标准的80例患者作为研究组,82例年龄相当的健康人群作为健康组,两组人群分别进行血清胱抑素C、血清肌酐及尿13微球蛋白的检测和相关性分析。结果研究组和健康组β2-组人群中血清胱抑素C、尿β2-微球蛋白间差异有统计学意义（P〈0．01）,血清肌酐间差异无统计学意义（P〉0．05）。研究组中血清胱抑素C与血清肌酐及尿β2-微球蛋白有较好的相关性,而且血清胱抑素C与尿β2-微球蛋白的相关性优于血清肌酐的相关性。结论血清胱抑素C和尿β2-微球蛋白的检测比血清肌酐的检测更能反映肾小球滤过功能的损害程度,是高尿酸血症肾损害早期诊断的敏感、有效指标。     

血清胱抑素-C是反映肾小球滤过功能的敏感指标

目的探讨测定血清胱抑素C(Cystatin C)浓度来判断肾小球滤过率的准确性与敏感性。方法对32例各种原因可能或已经肾功能轻-中度受损的患者，应用乳胶颗粒增强比浊法(PET)测定其血清CystatinC浓度，采用^99Tc-DTPA血浆清除率测定其肾小球滤过率(GFR)，同时测定血尿素氮(BUN)、血肌酐(SCr)，并根据Cockcroft-Cault公式计算肌酐清除率。结果血清Cystatin C浓度与上述指标均有相关性，并有显著性意义。血清Cystatin C比SCr与用^99Tc-DTPA测定的GFR有更好的一致性。结论血清Cystatin C浓度是一个反映肾小球滤过功能准确、敏感的指标。     

150例慢性肾脏病患者胰岛素抵抗指数的分布及其相关因素分析

目的观察慢性肾脏病患者胰岛素抵抗指数的分布及其相关因素。方法分析在南京医科大学第二附属医院肾脏科住院并确诊为慢性肾脏病的150例患者的病历资料,通过稳态模型分析法（HOMA2模型）定量评价胰岛素抵抗等指标。结果慢性肾脏病患者胰岛素抵抗指数均值为（2．85±1．67）,其中非糖尿病和2型糖尿病患者分别为（2．74±1．54）、（3．00±1．82）（P=0．356）。随着肾小球滤过率的降低,胰岛素抵抗指数呈增加趋势（Pfortrend＜0．01）。进行有序Logistic回归分析,单因素模型中胰岛素抵抗指数相关因素包括logl0（全段甲状旁腺素）、血磷、心力衰竭、高血压病史、尿蛋白、纤维蛋白原、胱抑素C、尿酸、收缩压、高密度脂蛋白胆固醇、肾小球滤过率、碳酸氢根,多因素模型中相关因素包括血磷、胱抑素C、血红蛋白、体质量指数、肾小球滤过率。患者的胰岛素分泌功能指数均值为（169．1％±91）．2％）,其中2型糖尿病患者低于非糖尿病患者（P=0．000）,胰岛素敏感性指数均值为（49．7％±31．3％）,非糖尿病患者与2型糖尿病患者相似且均降低（P=0．838）。结论本研究发现慢性肾脏病患者普遍存在胰岛素抵抗,并且随着肾脏损害的进展呈加重趋势。重视与慢性肾脏病有关的相关因素包括甲状旁腺素、血磷、尿蛋白、胱抑素C、血红蛋白、肾小球滤过率等。     

血清半胱氨酸蛋白酶抑制剂C在各期慢性肾脏病诊断中的应用价值

目的：探讨血清半胱氨酸蛋白酶抑制剂c（CystatinC）与血清肌酐（Scr）在不同时期慢性肾脏病（chronic kidney disease，CKD）患者肾功能检测中的敏感性，评价血清Cystatin C在各期CKD患者中的临床应用价值。方法：对129例不同时期CKD患者检测CystatinC，以^99mTc—DTPA清除率测得的肾小球滤过率（GFR）作为诊断评价的金指标，乳胶颗粒增强免疫透射比浊法检测血清CystatinC浓度，用全自动生化分析仪检测血清Scr。结果：与正常对照组比较，各期CKD组CystatinC值均有统计学差异，而各期CKD组Scr值与正常组比较，CKD1、CKD2期无统计学差异，CKD3～5期才有统计学差异；各期CKD组间比较显示CystatinC值均有统计学差异，而Scr值差异仅局限于CKD3～5期。并且血清CystatinC，Scr与^99mTc-DTPA清除率呈显著相关，尤其CystatinC相关性更好。结论：血清CystatinC在各期CKD中均能准确反映肾小球滤过功能，尤其能敏感提示早期肾功能损害，可成为判断肾功能损害程度的敏感指标，而且方法简便、敏感。     

Glomerular filtration rate estimated by cystatin C among different clinical presentations

Glomerular filtration rate (GFR) estimates from serum creatinine has not been generalizable across all populations. Cystatin C has been proposed as an alternative marker for estimating GFR. The objective of this study was to compare cystatin C with serum creatinine for estimating GFR among different clinical presentations. Cystatin C and serum creatinine levels were obtained from adult patients (n=460) during an evaluation that included a GFR measurement by iothalamate clearance. Medical records were abstracted for clinical presentation (healthy, native chronic kidney disease or transplant recipient) at the time of GFR measurement. GFR was modeled using the following variables: cystatin C (or serum creatinine), age, gender and clinical presentation. The relationship between cystatin C and GFR differed across clinical presentations. At the same cystatin C level, GFR was 19% higher in transplant recipients than in patients with native kidney disease (P<0.001). The association between cystatin C and GFR was stronger among native kidney disease patients than in healthy persons (P<0.001 for statistical interaction). Thus, a cystatin C equation was derived using only patients with native kidney disease (n=204). The correlation with GFR (r(2)=0.853) was slightly higher than a serum creatinine equation using the same sample (r(2)=0.827), the Modification of Diet in Renal Disease equation (r(2)=0.825) or the Cockcroft-Gault equation (r(2)=0.796). Averaged estimates between cystatin C and serum creatinine equations further improved correlation (r(2)=0.891). Cystatin C should not be interpreted as purely a marker of GFR. Other factors, possibly inflammation or immunosuppression therapy, affect cystatin C levels. While recognizing this limitation, cystatin C may improve GFR estimates in chronic kidney disease patients.     

Serum cystatin C as a marker of glomerular filtration rate

PURPOSE OF REVIEW: Glomerular filtration rate is widely accepted as the best overall measure of kidney function. Currently available methods to estimate glomerular filtration rate have strengths and limitations. Cystatin C is a novel endogenous filtration marker being considered as a potential replacement for serum creatinine. This review summarizes the currently available glomerular filtration rate estimating equations based on cystatin C and the literature comparing cystatin C and creatinine as filtration markers. RECENT FINDINGS: In most cystatin C estimating equations, inclusion of age and sex did not substantially improve their performance. Equations yield different glomerular filtration rate estimates for the same level of cystatin C. Variation among equations may be due to differences among the assays or populations in the individual studies. Studies comparing cystatin C with creatinine or creatinine-based estimating equations show heterogeneous results, with some showing improved performance and others showing equivalent performance even in similar populations. These heterogeneous results may be due to inappropriate comparisons between equations developed in one population with those developed in another, or to the differences between assays or population characteristics. SUMMARY: Cystatin C shows promise as an alternative to serum creatinine but several important questions remain before it can be recommended for use in clinical practice.     

血清胱抑素C在评价慢性肾脏病患者肾小球滤过率中的价值

目的：探讨血清胱抑素C（CystC）在评价慢性肾脏病（CKD）患者肾小球滤过率中的临床价值。方法：选取2009年4月～2009年11月住院的CKD患者76例,检测其血清CystC浓度,血清肌酐浓度（Scr）,以99mTc-二乙三胺五醋酸（99mTc-DTPA）法测定肾小球滤过率（GFR）,并用简化MDRD和Cockcroft-Gault（C-G）方程分别估测GFR（M-GFR,C-GFR）,以99mTc-GFR作为金标准,比较不同CKD分期间各指标间的相关性及其敏感度和特异度。结果：患者血清CystC、Scr、C-GFR、M-GFR与99mTc-GFR的相关系数分别为-0.81、-0.73、0.90、0.89,P均〈0.01,CystC在CKD1～3期与99mTc-GFR均有相关性,相关系数分别为-0.57（P〈0.05）,-0.44（P〈0.05）,-0.74（P〈0.01）,但在4～5期两者无明显相关关系（相关系数-0.30,P〉0.05）而Scr、C-GFR、M-GFR与99mTc-GFR仅在CKD3期患者中有相关性;在CKD1期患者中,CystC的敏感性和特异性均高于C-GFR和M-GFR。结论：血清CystC是一个反映CKD患者肾功能的较为敏感的指标,尤其在早期CKD患者中应用价值更大。     

Serum neutrophil gelatinase-associated lipocalin as a marker of renal function in non-diabetic patients with stage 2-4 chronic kidney disease

The current Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines advocate creatinine-based equations for estimating GFR to identify patients with potential kidney disease and classify them into different stages due to the fact that serum creatinine is very insensitive to changes in the glomerular filtration rate. Very few biomarkers exist for monitoring chronic kidney disease. The aim of the study was to assess whether NGAL could represent a novel, sensitive marker of kidney function in adult patients with CKD. The study was performed on 92 non-diabetic patients with CKD stages 2-4. Serum and urinary NGAL as well as serum cystatin C were measured using commercially available kits. Serum NGAL was related, in univariate analysis, to serum creatinine, urinary NGAL, hemoglobin, hematocrit, leukocyte count, eGFR, and cystatin C. Urinary NGAL correlated with age, hemoglobin, hematocrit, serum creatinine, and eGFR. In multiple regression analysis, predictors of serum NGAL were creatinine (beta value = 0.97, p = 0.005), cystatin C (beta = 0.34, p = 0.01), and eGFR (beta value = 1.77, p = 0.001). In the healthy volunteers, serum NGAL correlated with age, serum creatinine, eGFR, leukocyte count, and cystatin C. Taking into consideration the fact that the recent DOQI (Dialysis Outcomes Quality Initiative) states that individuals with reduced GRF (glomerular filtration rate) are at greater risk for CVD and cardiac deaths, precise evaluation of renal function is important in order to select the appropriate strategy to reduce the cardiovascular risk. NGAL should be investigated as a potential early and sensitive marker of kidney impairment/injury.     

Serum midkine is related to NYHA class and cystatin C in heart transplant recipients

Heart transplantation is now the established method of therapy for end-stage heart failure, with significantly improved outcomes over recent years. However, an increasingly prevalent complication in this population is that chronic kidney disease appears to be generally associated with subclinical inflammation. Midkine is a heparin-binding growth factor with various functions ranging from cell growth and survival to angiogenensis, repair, and inflammation. Recently, serum midkine has been reported to be a novel marker of cardiac events in heart failure patients. The aim of this study was to assess midkine concentration in 134 heart transplant recipients in relation to kidney function and New York Heart Association (NYHA) class. Heart transplant recipients had significantly higher serum creatinine, urea, cholesterol, triglycerides, fasting glucose, white blood cell count, and serum midkine, and lower estimated glomerular filtration rate than the control group. Serum midkine levels rose together with advancing NYHA class. Serum midkine was related to kidney function, NT-proBNP, transferrin, and prednisone dose. Cystatin C and NT-proBNP class turn out to be predictors of midkine in heart transplant recipients. Midkine levels are dependent on heart and kidney function, and might also represent a surrogate marker of subclinical inflammation.     

Serum Neutrophil Gelatinase-Associated Lipocalin as a Marker of Renal Function in Non-Diabetic Patients with Stage 2–4 Chronic Kidney Disease

The current Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines advocate creatinine-based equations for estimating GFR to identify patients with potential kidney disease and classify them into different stages due to the fact that serum creatinine is very insensitive to changes in the glomerular filtration rate. Very few biomarkers exist for monitoring chronic kidney disease. The aim of the study was to assess whether NGAL could represent a novel, sensitive marker of kidney function in adult patients with CKD. The study was performed on 92 non-diabetic patients with CKD stages 2–4. Serum and urinary NGAL as well as serum cystatin C were measured using commercially available kits. Serum NGAL was related, in univariate analysis, to serum creatinine, urinary NGAL, hemoglobin, hematocrit, leukocyte count, eGFR, and cystatin C. Urinary NGAL correlated with age, hemoglobin, hematocrit, serum creatinine, and eGFR. In multiple regression analysis, predictors of serum NGAL were creatinine (beta value = 0.97, p = 0.005), cystatin C (beta = 0.34, p = 0.01), and eGFR (beta value = 1.77, p = 0.001). In the healthy volunteers, serum NGAL correlated with age, serum creatinine, eGFR, leukocyte count, and cystatin C. Taking into consideration the fact that the recent DOQI (Dialysis Outcomes Quality Initiative) states that individuals with reduced GRF (glomerular filtration rate) are at greater risk for CVD and cardiac deaths, precise evaluation of renal function is important in order to select the appropriate strategy to reduce the cardiovascular risk. NGAL should be investigated as a potential early and sensitive marker of kidney impairment/injury.     

Serum cystatin C as an endogenous marker of renal function in patients with chronic kidney disease

The estimation of the glomerular filtration rate (GFR) is an essential part of the evaluation of patients with chronic kidney disease (CKD). Recently, serum cystatin C has been proposed as a new endogenous marker of GFR. Authors compared serum creatinine, creatinine clearance calculated from Cockcroft and Gault formula and serum cystatin C against (51)CrEDTA clearance in 252 patients with CKD and GFR <90 mL/min/1.73 m(2). Analysis of correlations and diagnostic accuracy (receiver operating characteristic curves) of different GFR markers indicate that serum cystatin C is a more reliable marker of GFR in patients with CKD than serum creatinine.     

Update on cystatin C: new insights into the importance of mild kidney dysfunction

PURPOSE OF REVIEW: Using cystatin C, a novel serum marker of kidney function, several studies have shown that mild kidney dysfunction is associated with increased risk for cardiovascular disease and mortality. Studies have questioned, however, whether cystatin C is predominantly a measure of kidney function. This review summarizes the research literature on cystatin C. RECENT FINDINGS: One longitudinal study in patients with diabetes found cystatin C to approximate glomerular filtration rate measures over 4 years much better than creatinine. Studies in several cohorts found cystatin C to be linearly associated with mortality, cardiovascular mortality, and heart failure risk, whereas creatinine predicted increased risk only in subjects with the worst kidney function. One study, however, found that increased age, male sex, increased height and weight, smoking, and higher C-reactive protein levels were associated with cystatin C after adjustment for creatinine clearance, which may suggest nonrenal influences on cystatin C concentrations. SUMMARY: Cystatin C appears to capture the association of mild kidney dysfunction with increased risk for cardiovascular disease and death. Future research needs to evaluate whether cystatin C will have an important role in clinical medicine.     

Development of chronic kidney disease in essential hypertension during long-term therapy

PURPOSE OF REVIEW: This review examines the relevance of the development of chronic kidney disease in long-term hypertensive patients on the cardiovascular prognosis. RECENT FINDINGS: Recently published guidelines recognize the relevance of the development of chronic kidney disease in the stratification of risk for the hypertensive patient. An adequate assessment of renal function, including an estimation of the glomerular filtration rate, is mandatory in order to ensure an adequate evaluation of the global cardiovascular risk in the hypertensive patient. The presence of subtle elevations in serum creatinine concentrations is a potent predictor of a poor cardiovascular prognosis. The clustering of associated risk factors seems to justify the elevated cardiovascular risk observed in patients with essential hypertension and mild renal function derangement. SUMMARY: Chronic kidney disease is associated with a significant increase in cardiovascular risk attributable to the simultaneous existence of other risk factors related to the metabolic syndrome. The high prevalence of chronic kidney disease in the general and hypertensive populations forces the recognition of its relevance and the need for an integrated therapeutic approach simultaneously to protect the renal and cardiovascular systems fully.