半胱氨酸蛋白酶抑制剂C在早期肾功能损害中的诊断意义

目的：探讨半胱氨酸蛋白酶抑制剂C（CystatinC,简称CystC）在早期肾功能损害中的诊断意义。方法：采用免疫散射法测定血清CystC的浓度,酶法测定血清肌酐（Scr）、24h尿肌酐,计算内生肌酐清除率（Ccr）。比较CystC、Scr分别与Ccr的相关性。结果：当Ccr在50～80ml/min时,Scr与正常对照无差异（P〉0.05）,而CystC与正常对照差异显著（P〈0.05）,而当Ccr〈50ml/min时Scr、CystC与正常对照组及Ccr≥80ml/min组相比,差异有统计学意义（P〈0.05）。结论：血清CystC敏感性高于Scr,对早期肾小球滤过功能受损的诊断有重要的意义。     

血清胱蛋白酶抑制剂C测定对评价小儿肾功能的临床意义

目的：探讨在肾脏疾病中检测血清胱蛋白酶抑制剂C（Cystatin C,Cys C）浓度评价小儿肾小球滤过率（GFR）的价值。方法：用ELISA法测定65例肾脏病患儿血清Cys C浓度，同时每例患儿均测定血清肌酐（Scr）、血尿素氮（BUN），计算24h肌酐清除率（Ccr），依据Ccr结果将患儿分为4组，分别比较肾功能降低各组与肾功能正常组血清Cv。C、BUN及Scr的结果，并分析血清Cysc、BUN、Scr与Ccr的相关性。结果：在肾功能不全代偿期患儿中血清Cys C与肾功能正常组比较差异有统计学意义（P〈0.01），而Scr、BUN与肾功能正常组比较差异无统计学意义（P〉0．05）。血清Cys C、Scr、BUN与Ccr均呈显著负相关。结论：临床上用检测血清Cys C浓度来评价肾小球滤过功能的准确性优于Scr、BUN，尤其对早期肾功能损害更加敏感，其方法简单、快捷、便于临床推广。     

CystatinC在肾功能损害诊断中的临床应用

目的探讨血清半胱氨酸蛋白酶抑制剂C（CystafinC）在早期肾功能损害诊断中的应用价值。方法对63例肾脏损害患者的血清Cystatinc、血清肌酐（serumcreafinine,Scr）和内生肌酐清除率（endogenous creatinine clearancerate,Ccr）的测定结果进行比较。结果检测血清CystatinC是临床早期诊断肾功能损害的有效方法。结论半胱氨酸蛋白酶抑制剂C（CystatinC）现已替代血清肌酐作为评估肾小球滤过率的较好指标,其在临床早期诊断肾功能损害中有着重要的意义。     

血清胱抑素C与血肌酐在肾功损害中的比较分析

目的比较肾功损害时血清胱抑素C（Cys—C）和血肌酐（Scr）的变化情况,从而评价二者在肾功损害中的应用价值。方法收集不同程度肾功损害患者120例,同时收集本院正常体检者50例,测定内生肌酐清除率（Ccr）、Cys—C和Scr。结果各组之间的Cys．C的水平均有显著统计学差异（P〈0．01）,升高程度与肾功的损害程度呈正相关;肾功不全代偿组与正常对照组相比,血清胱抑素水平有差异（P〈0．05）,而Scr水平无显著性差异（P〉0．05）。结论与Scr相比,Cys—C水平是一种能够更灵敏、更准确、更直观、更可靠的反映肾小球滤过功能损害的指标,是评价肾小球滤过功能的最佳的内源性标志物。     

肾小球滤过功能检测在糖尿病肾病中的诊断价值

目的探讨血清胱抑素C（Cys-C）、血清肌酐（Scr）、尿素（Urea）和肌酐清除率（Ccr）在糖尿病肾病患者中的早期诊断价值。方法将128例2型糖尿病患者按24h尿微量白蛋白水平分为3组,A组为正常蛋白尿患者49例（UMA〈30mg/24h）,B组为微量蛋白尿患者45例（UMA30～300mg/24h）,C组为大量蛋白尿患者34例（UMA〉300mg/24h或常规蛋白阳性）,测定血清胱抑素C（Cys-C）、血清肌酐（Scr）、尿素氮（Urea）,并计算肌酐清除率（Ccr）。结果血清胱抑素C（Cys-C）在各组间差异有统计学意义（P〈0.01）;而Scr、Urea、Ccr在A组和B组间差异无统计学意义（P〉0.05）;C组的Scr、Urea、Ccr高于A组和B组,差异有统计学意义（P〈0.01）。结论血清胱抑素C是糖尿病肾病早期诊断的敏感指标。     

对慢性肾脏疾病患者血清半胱氨酸蛋白酶抑制剂C的评价

目的探讨血清半胱氨酸蛋白酶抑制剂C(Cystatin C)的检测对慢性肾脏病(CKD)患者的诊断价值。方法检测67例肾病患者与32名健康对照者的血清CystatinC、血尿素(Urea)、血肌酐(Scr)、肌酐清除率(Ccr),并对患者组和正常组进行方法学评价。结果肾病患者的血清CystatinC、肌酐清除率(Ccr),与正常对照组比较,差异有极显著性(P<0.01),而血尿素(Urea)、血肌酐(Scr)差异无显著性。结论 Cystatin C的检测对慢性肾脏病(CKD)患者的诊断很有价值。     

胱氨酸蛋白酶抑制剂C在高血压肾病中的诊断作用

目的:探讨血清胱氨酸蛋白酶抑制剂C(Cystatin C)在高血压肾病中的诊断价值.方法:92例高血压患者按尿白蛋白排泄率(UAER)分为3组,正常蛋白尿组(Ⅰ组)(UAER＜20 μg/min)30例,微量蛋白尿组(Ⅱ组)(UAER 20～199μg/min)33例和大量蛋白尿组(Ⅲ组)(UAER≥200 μg/min)29例,设立对照组(健康体检合格者).测定各组Cystatin C、血清肌酐(Scr)、肌酐清除率(Ccr).进而对各指标进行比较分析和相关性分析.结果:在高血压患者中所测的Cystatin C平均值高于对照组(P＜0.05),而Scr在Ⅰ组和Ⅱ组中所测的平均值并无明显差异,且Cystatin C与Ccr的相关性较Scr与Ccr的相关性好,随着尿蛋白的增加而增加.结论:Cystatin C是临床上评定高血压肾病的敏感指标.在高血压肾病的早期诊断较血清肌酐更敏感.     

糖尿病肾病患者血清半胱氨酸蛋白酶抑制剂C的检测分析与临床检验学研究

目的研究分析血清半胱氨酸蛋白酶抑制剂C(Cystatin C)在糖尿病肾病中的应用价值与临床意义。方法将156例糖尿病患者按白蛋白排泄率(UAER)分为3组,正常蛋白尿组(1组)42例,微量蛋白尿组(2组)60例和大量蛋白尿组(3组)54例,设立对照组(健康体检合格者)。测定各组Cystatin C、血清肌酐(Scr)、肌酐清除率(Ccr)。进而对各指标使用SPSS11.0统计软件进行比较分析和相关性分析。结果在糖尿病患者中所测的Cystatin C平均值高于对照组(P<0.05),而血清肌酐在1组和2组中所测的平均值并无明显差别,且Cystatin C与Ccr的相关性较Scr与Ccr的相关性好。结论血Cystatin C对2型糖尿病肾病的早期诊断较血清肌酐更敏感。     

血清胱抑素C的检测对早期肾功能损害价值的探讨

目的 探讨血清胱抑素C（Cys-C）的检测在诊断早期肾功能损害中的应用价值.方法 将253例肾损害疾病患者根据肌酐清除率（Ccr）测量值大小分为肾功能正常组（A组）、肾功能轻度损害组（B组）、肾功能中度损害组（C组）、重度损害及尿毒症组（D组）4组,选取60名作为健康对照组,用颗粒增强散射免疫法检测血清Cys-C的浓度,同时用酶法检测血肌酐（Scr）、血尿素氮（BUN）、肌酐清除率（Ccr）,并对各组血清Cys-C、Scr和BUN进行分析比较.结果 肾病患者中肾功能正常组（A组）和肾功能轻度损害组（B组）仅Cys-C与健康对照组差异有高度统计学意义（P〈0.01）,而在肾功能中度损害组（C组）、重度损害及尿毒症组（D组）的Cys-C、Scr和BUN均与健康对照组差异有统计学意义（P〈0.01或P〈0.05）.结论 血清Cys-C是肾功能早期损害的灵敏诊断指标,可早期判断肾小球滤过功能损害.     

血清胱抑素C在肾功能损害评估中的临床价值

目的：通过对肾功能损害程度不同患者血清Cyc—C水平进行测定，并与Ccr进行相关性分析，研究其在评价肾功能早期损害中的临床价值。方法：对143例患者分组进行血清标本检测。结果：各组间Cyc—C值均有显著性差异（P〈0．05），随肾功能损害程度增加，Cyc呈显著性升高。结论：Cyc—C是判断肾小球滤过功能的较敏感指标．临床价值可能优于Scr和Ccr，对于评估肾功能的早期损害程度可能更为重要。     

Serum cystatin C as an endogenous marker of renal function in the elderly

The glomerular filtration rate (GFR) is the main indicator of kidney function. In clinical practice the GFR is often estimated from serum creatinine. In the elderly, serum creatinine is notoriously unreliable as an estimator of GFR. Recently, serum cystatin C has been proposed as a new endogenous marker of glomerular filtration rate. A total of 144 patients, aged more than 60 years (mean age 70.4 years), who had undergone 51CrEDTA clearance, were enrolled in our study. In each patient serum creatinine and serum cystatin C were determined. The reciprocal of serum creatinine, the reciprocal of serum cystatin C and creatinine clearance (from Cockcroft and Gault formula) were calculated. Serum cystatin C was measured with the particle-enhanced immunonephelometric method. The mean 51CrEDTA clearance was 34.5+/-25.55 ml/min/1.73 m2, the mean serum creatinine was 312+/-210 micromol/l and the mean serum cystatin C 3.15 mg/l+/-1.62 mg/l. We found a significant correlation between 51CrEDTA clearance and serum creatinine, serum cystatin C, the reciprocal of serum creatinine and the reciprocal of serum cystatin C as well as with creatinine clearance. In comparison of the correlation coefficients we found that the correlation between 51CrEDTA clearance and serum cystatin C was significantly better than that with serum creatinine (p < 0.05). The correlation between 51CrEDTA clearance and the reciprocal of serum cystatin C was superior to that with the reciprocal of serum creatinine (p < 0.003) and calculated creatinine clearance (p < 0.003). Our results indicate that serum cystatin C is a more reliable marker of GFR in the elderly than serum creatinine or creatinine clearance.     

肌酐在糖尿病患者肾小球滤过功能评价中的作用

目的：探讨肌酐在糖尿病患者肾小球滤过功能评价中的作用。方法选择糖尿病患者75例,选择健康体检者67例,测定入组者的血清肌酐值和血清胱抑素C值,并进行比较。结果肌酐对发生中重度肾功能损害的糖尿病患者的肾功能有较好的评价。结论对仅发生轻度肾功能损害的糖尿病患者的肾功能进行评价时,血清Cr敏感性较差。     

四组不同程度肾损害患者血清胱抑素C水平检测结果分析

目的通过检测血清胱抑素(CysC)水平,探讨其在肾功能损害及肾损伤早期诊断中的应用价值。方法对150例不同程度肾脏疾病患者按肾小球滤过率(eGFR)的不同分成四组观察组,100例体检健康者为正常对照组,用颗粒加强散射免疫比浊法测定胱抑素C水平,同时检测血清肌酐(Scr)、尿素氮(Bun)、尿肌酐(Ucr)并计算出eGFR。结果随着eGFR的下降,胱抑素测定值分别是(1.25±0.16)mg/L、(1.51±0.19)mg/L、(2.52±0.21)mg/L、(5.18±0.23)mg/L。差异有统计学意义,同时在肾小球滤过率大于50mL/min时,只有胱抑素升高。结论血清胱抑素C是反映肾功能损伤的敏感指标,在临床应用上,优于尿素氮、肌酐和内生肌酐清除率的检测,同时与肾病患者病程发展呈正相关。     

糖尿病肾病患者血清CysC浓度与SCr、Ccr、β_2-MG比较临床观察

目的通过检测血清胱抑素C（Cys-C）,与血清肌酐（SCr）、内生肌酐清除值（Ccr）、β2微球蛋白（β2-MG）结果进行比较,评价其对糖尿病肾病患者早期诊断的价值。方法应用颗粒增强免疫比浊法测定50例健康体检者和100例糖尿病患者的血清胱抑素C、血清肌酐、β2微球蛋白浓度,并同时测量100例患者尿肌酐（UCr）、尿微量白蛋白（MALB）并计算出内生肌酐清除值以及24h尿微量白蛋白。结果早期糖尿病肾病组Cys-C（1.61±0.82）、β2-MG（2.49±1.00）和临床糖尿病肾病组的Cys-C（2.27±1.16）、β2-MG（3.18±1.40）均较单纯糖尿病组Cys-C（0.90±0.19）、β2MG（1.58±0.39）、和正常对照组的检测结果明显增高,有显著差异（P〈0.01）;单纯糖尿病组Cys-C、β2-MG、SCr和Ccr检测结果和正常对照组比较无显著差异。检验数据分析得知,在早期糖尿病肾病组中,Cys-C、β2-MG和Ccr、SCr阳性率分别为71.8%、93.7%、31.2%、3.1%;在临床糖尿病肾病组中,Cys-C、β2-MG和Ccr、SCr阳性率分别为89.2%、81.2%、60.7%、50%。Cys-C与β2-MG的相关系数r=0.8211,P〈0.01,差异有显著性。结论通过检验数据分析,对血清Cys-C浓度与SCr、Ccr、β2-MG临床比较观察,胱抑素C用于评价糖尿病患者的肾功能状况,其特异性好于β2微球蛋白,灵敏度高于Ccr、SCr,是一个能较好反映肾小球滤过率的指标。     

Renal tubular injury is present in acute inflammatory bowel disease prior to the introduction of drug therapy

BACKGROUND: 5-aminosalicylic acid (5-ASA) has been associated with renal complications in inflammatory bowel disease. Renal function is typically monitored using serum creatinine; however, significant disease may predate increases in creatinine. AIMS: To identify whether markers of early renal disease (urinary albumin, alpha-1-microglobulin [alpha-1-M] and N-acetyl-beta-D-glucosaminidase [NAG], and serum cystatin C) are useful in the assessment of renal function in inflammatory bowel disease patients receiving 5-ASA. METHODS: Twenty-one patients with a new diagnosis of inflammatory bowel disease were investigated. Samples were taken at diagnosis, and at 3-monthly intervals after the commencement of 5-ASA, for 1 year. RESULTS: Mean creatinine clearance was 100 mL/min and did not change following treatment. Inflammatory bowel disease was not associated with albuminuria. Urinary N-acetyl-beta-D-glucosaminidase and alpha-1-microglobulin at diagnosis were increased in 10 (48%) and 11 (52%) patients, respectively: treatment was not associated with consistent changes in urinary protein excretion. There was a significant correlation between cystatin C and creatinine clearance both at diagnosis (r=-0.533, P=0.0275) and combining the initial and follow-up data (r=-0.601, P < 0.01), but not between creatinine and creatinine clearance (P > 0.05). CONCLUSIONS: Tubular proteinuria is an extra-intestinal manifestation of inflammatory bowel disease irrespective of 5-ASA treatment. Tubular proteins are not useful predictors of an adverse renal response to 5-ASA. Serum cystatin C may be an improved marker of glomerular filtration rate in this setting.     

血清胱抑素C在早期糖尿病肾病患者的临床表达

目的 探讨血清胱抑素C(CysC)对糖尿病早期肾损害的诊断价值.方法 分别检测53例2型糖尿病患者(研究对象)和20例健康人员(对照组:N组)的血清CysC、β2-MG、血清肌酐(Scr)、内生肌酐清除率(Ccr)等相关指标进行比较.结果 CysC、β2-MG、Ccr均与VAER有良好的相关性,CysC与相关指标的相关性最强.结论 血CysC较血肌酐、内生肌酐清除率能更敏感、更准确的反映2型糖尿病早期肾损害,是肾脏早期损伤的重要标志.     

还原型谷胱甘肽联合尿毒清颗粒治疗慢性肾功能衰竭的临床观察

目的:观察还原型谷胱甘肽联合尿毒清颗粒治疗慢性肾功能衰竭的临床疗效。方法:将80例慢性肾功能衰竭患者随机均分为2组,2组均给予尿毒清颗粒及常规对症治疗,治疗组在此基础上加用还原型谷胱甘肽治疗。观察2组的疗效及治疗前后血尿素氮(BUN)、血清肌酐(Scr)、内生肌酐清除率(CCr)、血清胱抑素C(CysC)等生化指标的恢复情况。结果:治疗组和对照组的总有效率分别为90.0%和67.5%,治疗组明显优于对照组(P<0.05)。与对照组比较,治疗组在降低BUN、Scr、CysC水平,提高CCr水平等方面均优于对照组,且差异有统计学意义(P<0.05)。2组不良反应均较轻微。结论:还原型谷胱甘肽配合尿毒清颗粒治疗慢性肾功能衰竭疗效肯定。     

肝肾综合征患者血清胱抑素C检测的临床评价

目的探讨血清胱抑素C(CysC)检测在肝肾综合征(HRS)诊断中的价值。方法以24小时肌酐清除率(24h-Ccr)作为肾小球滤过率(GFR)评估标准,将72例晚期肝硬化患者分为HRS组和非HRS组,同时设40例健康人作为正常对照组。所有待测者均测定血清CysC、血肌酐(Scr)、尿肌酐(Ucr)和血尿素氮(BUN)。比较分析各组间24-Ccr、CysC、Scr与BUN的水平差异、CysC、Scr、BUN与24-Ccr的相关性及其诊断的准确性。结果 CysC水平在HRS组与非HRS组间有非常显著性差异(P<0.01),而Scr与BUN在HRS与非HRS组间无显著性差异;CysC与24-Ccr的相关性最好,诊断灵敏度和特异度均优于Scr和BUN。结论 CysC能灵敏反映肝硬化患者肾功能早期损害,是评估HRS患者GFR较理想的指标。     

Serum cystatin C is not a better marker of creatinine or digoxin clearance than serum creatinine

AIMS: To assess whether cystatin C, a new serum marker of renal function, is a better index of creatinine or digoxin clearance than serum creatinine in older people. METHODS: Twenty-two volunteers over the age of 65 years (mean 73 +/- 5) were recruited from a healthy elderly volunteer database. None of the volunteers was taking digoxin or other medication known to interfere with digoxin kinetics or assay. Digoxin was infused at a dose of 7-10 microg kg(-1) and blood samples were taken over the following 48 h and assayed for serum digoxin. Serum cystatin C, creatinine and creatinine clearance were measured and a calculated creatinine clearance was estimated using the Cockcroft Gault formula. Digoxin clearance was calculated using a pharmacokinetic software package. All values were log transformed to normalize their distribution. RESULTS: Of the 22 volunteers enrolled into the study, 18 completed the study. Serum cystatin C ranged between 0.72 and 1.89 mg l(-1) and serum creatinine ranged from 69.6 to 153.9 micromol l(-1). Measured creatinine clearance ranged from 38 to 123 ml min(-1) and calculated creatinine clearance from 29.5 to 88.0 ml min(-1). Digoxin clearance ranged from 51.0 to 103.5 ml min(-1). Cystatin C correlated extremely well with creatinine (r=0.93, P<0.001, 95% CI 0.82, 0.97) and with creatinine clearance (r=0.67, P=0.002, 95% CI 0.3, 0.87). Neither serum cystatin C nor serum creatinine correlated with digoxin clearance (r=0.25, P=0.31, 95% CI -0.25, 0.64 and r=0.44, P=0.068, 95% CI -0.03, 0.75, respectively). Measured creatinine clearance, however, did correlate well with digoxin clearance (r=0.55, P=0.018, 95% CI 0.11, 0.81). CONCLUSIONS: Serum cystatin C and serum creatinine show very similar correlations with creatinine and digoxin clearances. Serum cystatin C does not offer any advantages in this respect. It remains to be seen whether cystatin C offers any advantage over creatinine in elderly people in other respects.