动态监测血清胱抑素 C 评价肾移植术后肾功能的改变

目的 监测肾移植受者血清胱抑素C(Cys C)浓度以评估移植肾功能的改变. 方法 监测58例肾移植成功受者术前及术后不同时间的血清Cys C、肌酐(SCr)、β2-微球蛋白(β2-MG)和尿素氮(BUN)水平;并于术后第7天使用99mTc-DTPA测定受者肾小球虑过滤(GFR),比较其与上述四项指标的相关性.以GFR=1.5 ml/s为临界值,绘制ROC曲线,比较各项检测指标鉴别轻度与中重度肾功能损伤的诊断性能.计算受者不同时间段血清Cys C及SCr变异系数及其比值(R值). 结果 Cys C于术后第1天下降达48.1%,明显大于其他指标的下降幅度.血清Cys C、SCr、β2-MG和BUN与GFR相关系数依次为0.876、0.691、0.589和0.516.血清Cys C、SCr、β2-MG和BUN的诊断性能:敏感性分别为91.3%、87.2%、82.6%和87.0%;特异性分别为80.0%、69.2%、71.4%和42.9%;阳性预期值分别为82.0%、73.7%、74.3%和60.4%;阳性似然比分别为4.81、2.83、2.87和1.53;ROC曲线下面积(AUC)分别为0.914、0.828、0.803和0.765.SCr的变异系数显著小于Cys C(P＜0.01),Cys C＜2 mg/L的受者R值大多＜1,Cys C＞2 mg/L的受者,伴随Cys C水平升高,R值趋近于1. 结论 Cys C与GFR相关性最好;Cys C的诊断性能及准确性均优于其他指标,即使肾功能有微小损伤,Cys C也会有显著改变.因此,肾移植术后动态监测Cys C对于及时判断移植肾存活及肾微小损伤时肾功能的改变优于其他指标.     

肾移植术后一年时的肾小球滤过率与移植肾长期功能的相关性研究

目的 探讨肾移植受者术后1年时的肾小球滤过率(GFR)与移植肾长期功能的相关性. 方法 回顾性分析1994年11月至2004年10月间334例肾移植受者的临床资料.根据术后1年时的GFR不同,将受者分成肾功能正常组(≥1.083 ml/s; 267例)和肾功能异常组(GFR＜1.083 ml/s;67例))GFR采用Coekeroft-Gault(C-G)公式进行计算.采用Kaplan-Meier方法比较两组受者术后5年时移植肾的长期存活率;分析术后1年与术后5年时GFR的相关性. 结果 肾移植术后移植肾存活率呈现逐年下降趋势,术后1年时的GFR与移植肾存活时间成正比,术后同一时间点(5年、10年),肾功能正常组(不包括或包括肾功能正常的死亡者)移植.肾的长期存活率均高于肾功能异常组,两组比较,差异有统计学意义(P＜0.05).与术后1年时GFR比较,术后5年时的GFR变化幅度为(0.080±0.248)ml/s,其下降程度与术后1年时的GFR呈现明显正相关性. 结论 术后1年时的GFR水平影响移植肾的长期功能,术后1年时的GFR越高,术后5年的GFR也越高.     

血清胱抑素C对肝硬化病人肾功能损害的早期诊断价值研究

目的 探讨血清半胱氨酸蛋白酶抑制剂C(Cys C)检测对肝硬化病人肾功能损害早期诊断的意义.方法 测定76例肝硬化病人24 h肌酐清除率(Ccr)以及血清肌酐(SCr)和血清Cys C水平.以CCr＜80 ml/min/1.73 m2作为肾功能损害诊断标准,采用t检验、相关性分析和ROC曲线分析探讨Cys C的诊断价值.结果 在Child分级肝损害病人的肾功能评估能力比较中,Cys C能灵敏反映CCr变化,而Scr的反映能力明显低于Cys C.SCr与CCr有着显著的负相关性(CysC:r=-0.763,P＜0.001;SCr:r=-0.571,P＜0.01),而Cys C的相关系数较高.ROC曲线分析显示Cys C的曲线下面积(AUC)值明显高于SCr(0.830比0.612).结论 与SCr比较,Cys C能更准确地早期发现肝硬化病人的肾功能损害,常规监测肝硬化病人Cys C水平,对预防肝肾综合征的发生具有积极意义.     

肾移植术后患者血清半胱氨酸蛋白酶抑制物水平与肾功能的关系

目的 探讨肾移植术后患者血清半胱氨酸蛋白酶抑制物(CyC)的水平变化与移植肾功能的相关性.方法选择193例使用他克莫司(FK506)加霉酚酸酯(MMF)加泼尼松(Pred)三联免疫抑制剂肾移植患者术后的血、尿标本,测定血清CyC和血、尿肌酐.经统计学分析,与常规的血清肌酐(SCr)浓度及尿肌酐清除率(CCr)和内生肌酐清除率(CkCCr)作相关性比较,评估CyC判断移植肾肾小球滤过功能的敏感性和特异性.结果 193例肾移植患者术后第5天血清CyC、SCr和CCr、CkCCr分别为(1.91±1.28)mg/L、(174.2±129.1)μmol/L、(67.9±27.3)ml/min、(68.1±27.8)ml/min.其中CyC浓度＜1.25 mg/L者42例,1.25～2.00 mg/L者102例,＞2.0 mg/L者49例;SCr浓度＜125/μmol/L者62例,125～200μmol/L者83例,＞200/μmol/L者48例;CkCCr＞80ml/min者52例,80～60 ml/min者96例,＜60 ml/min者45例.CyC与SCr呈正相关(r=0.886,P＜0.001),与CkCCr呈负相关(r=-0.907,P＜0.001);SCr与CkCCr呈负相关(r=-0.889,P＜0.001).非参数受试者工作特征曲线分析CyC、SCr、CCr、CkCCr曲线下面积分别为0.877、0.771、0.832、0.909,其诊断敏感性和特异性分别为91.6%、69.3%,52.2%、96.1%,67.5%、77.1%和84.6%、71.3%. 结论 肾功能轻度损害时,血清CyC比SCr先一步增高,有可能成为评定肾移植患者移植肾功能的敏感性标志物.     

肾移植术后血清抗MICA抗体与慢性排斥反应的相关性

目的 探讨肾移植受者的抗MICA抗体水平与慢性排斥反应的相关性及其对移植肾功能的影响.方法 共有105例受者被作为研究对象纳入分析,其中发生慢性排斥反应者(慢排组)43例,移植肾功能正常者(对照组)62例.记录两组受者术前群体反应性抗体(PRA)、HLA抗原错配数、供肾冷缺血时间、出院时血清肌酐(SCr)水平、术后免疫抑制方案以及入组时间(入组时距肾移植手术时间)等资料,并进行比较.受者分组后,抽取受者外周血,检测SCr及抗MICA抗体水平,抗MICA抗体的检测采用Luminex 100免疫磁珠流式细胞仪技术.观察与比较抗MICA抗体阳性受者和抗MICA抗体阴性受者间术后3个月内发生急性排斥反应(AR)的次数和移植肾功能的差异.移植肾功能的评价采用血清肌酐变化率(△SCr/M),即(入组时SCr值-出院时SCr值)/入组时间.结果 两组受者在性别、年龄、HLA抗原错配数、供肾冷缺血时间、术后免疫抑制方案、出院时SCr水平及入组时间的比较,差异均无统计学意义(P＞0.05).分组后,慢排组受者SCr水平和抗MICA抗体阳性受者比例均明显高于对照组,两组比较,差别均有统计学意义(P＜0.01,表1).抗MICA抗体阳性受者术后3个月内发生的AR次数明显多于抗MICA抗体阴性受者,二者比较,差异有统计学意义(P＜0.05).抗MICA抗体阳性受者的△SCr/M为8.3±3.6,明显高于抗MICA抗体阴性受者的2.4±2.6,二者比较,差异有统计学意义(P＜0.05).结论 抗MICA抗体的表达与慢性排斥反应的发生相关,移植前进行MICA配型可减少术后移植肾慢性排斥反应的发生,有助于延长移植肾的长期存活.     

扩大供肾标准的亲属肾移植临床效果分析

目的 探讨扩大供肾标准的亲属肾移植临床效果.方法 回顾性分析2005年11月至2011年6月亲属活体肾移植274例的临床资料,按供者情况分为扩大供者标准(供者年龄≥60岁、肾脏解剖结构/功能异常)组(66例)和标准供者组(208例).扩大标准组供者年龄≥60岁36例,其中合并肾囊肿6例,合并肾结石1例;肾囊肿22例,囊肿直径4～40 mm;肾结石4例,结石直径3 ～～6 mm;术侧肾小球滤过率(GFR) ＜35 ml/min 4例.统计学比较两组受者术后3、7d,l、3、6、12个月血清SCr值、并发症发生率、急性排斥反应发生率、移植肾功能延迟恢复(DGF)发生率,1、3年人/肾存活率.结果 扩大标准组及标准供者组受者术后3、7d血清SCr值分别为(242.7±132.2)、( 185.6±148.4) μmol/L和(156.7±86.8)、( 122.2±136.8) μmol/L,两组受者第3天与第7天SCr值比较差异均有统计学意义(P＜0.05);但两组受者术后1、3、6、12个月血SCr、并发症发生率、急性排斥反应发生率、DGF发生率,1、3年人/肾存活率之间比较差异均无统计学意义(P＞0.05).结论 ≥60岁健康高龄、直径＜40 mm供肾囊肿仍可考虑作为亲属肾移植供者;低GFR应结合供者年龄、供受者体表面积比、供受者体质量比、可通过外科处理纠正等方面综合考虑;供肾结石者应慎重选择.     

高龄供者血清Klotho水平预测受者术后移植肾功能状态的临床研究

目的探讨高龄供者血清Klotho水平预测受者移植肾功能的可行性。方法选取16例高龄供者和相应27例肾移植受者的临床资料。观察肾移植受者的一般情况。检测高龄供者器官获取手术当日血清Klotho和血清肌酐(Scr)水平。检测肾移植受者术后1、3、12个月的Scr水平,计算估算肾小球滤过率(eGFR),分析供者血清Klotho水平与受者术后移植肾功能的相关性。结果肾移植术中的冷缺血时间为(649±245)min,受者移植物功能延迟恢复(DGF)发生率为26%,急性排斥反应发生率为7%。高龄供者血清Klotho水平为537(245～793)pg/m L,Scr水平为(164±62)μmol/L。受者术后1、3、12个月的Scr水平分别为(136±47)、(132±43)、(133±46)μmol/L,相应的e GFR分别为(52±20)、(52±19)、(53±21)m L/(min·1.73 m~2)。高龄供者血清Klotho水平与受者术后1个月移植肾功能呈负相关(P0.05)。血清Klotho水平预测术后1个月移植肾功能不全的灵敏度和特异度分别为0.909和0.769。结论高龄供者术前血清Klotho水平对受者术后1个月移植肾功能具有预测价值。     

移植肾的病理类型与肾功能及预后的关系——单中心十年经验回顾分析

目的 分析肾移植受者移植肾的病理类型和特征,及其与肾功能和预后的关系.方法 肾移植术后230例受者接受了移植肾穿刺病理活检,分析其病理表现类型和特征,比较不同病理类型和特征受者移植肾穿刺活检时的血肌酐(SCr)水平,随访受者穿刺活检后1年的移植肾功能情况,评价不同病理特征受者的预后.结果 移植术后3个月时接受了程序性肾活检的10例受者中,9例为正常肾组织,1例为移植后IgA肾病.有肾功能损害临床表现的220例受者中,病理表现为交界性改变33例,急性排斥反应(AR)45例,慢性排斥反应(CR)24例,慢性移植肾肾病(CAN)26例,移植后肾炎(PTGN)39例,以上共167例;另外,28例同时有前面两种或两种以上的病理类型表现,还有CNI肾毒性反应8例,BK病毒肾病7例,急性肾小管坏死5例.有5例受者因采集的移植肾组织过少而不能明确诊断.病理诊断为交界性改变、AR、CR、CAN和PTGN的受者,其穿刺活检时的SCr水平分别为(171±17)、(259±25)、(343±33)、(406±67)和(207±26)μmol/L,不同病理类型者的SCr水平两两比较,差异均有统计学意义(P＜0.01).穿刺活检后1年,随访到上述5种病理类型167例受者中的134例(80.2%),其中交界性改变23例、AR 36例、CR 20例、CAN 18例及PTGN37例,分别有1例(3.1%)、8例(18.2%)、8例(22.2%)、6例(33.3%)、5例(13.5%)发生移植肾功能丧失.穿刺活检后1年,上述5种病理类型移植肾功能异常受者的SCr水平与穿刺时SCr水平的差值(△SCr)分别为(-47±20.7)、(-37.3±36.9)、(25.5±24.3)、(13.5±27.7)和(25.2±17.1)μmol/L.结论 移植肾的病理改变复杂多样,结合移植肾穿刺病理活检结果和临床分析进行准确诊断,可以帮助临床选择合适的治疗方案,促进移植肾的长期存活.     

血清半胱氨酸蛋白酶抑制剂C 对肝脏切除术患者术后肾功能监测的临床价值

目的 探讨血清半胱氨酸蛋白酶抑制剂C(Cystatin C,Cys C)监测对肝脏手术后患者肾功能水平的临床价值.方法 测定141例肝脏手术患者术后的24 h 肌酐清除率(24 hccr)、血清肌酐(SCr)以及血清Cystatin C(Cys C)水平,并以CCr<80 mL/min/1.73 m2 作为肾功能损害诊断标准,采用χ2检验、相关性分析和ROC 曲线分析了解Cys C 的诊断价值.结果 141 例患者中共有32 例出现CCr 下降,在这32 例患者中,CysC 水平上升的有28 例,而SCr 出现异常的仅有15 例,χ2检验分析后提示CysC 对CCr 的评估效能优于SCr(P<0.05).相关性分析提示在该类患者中,Cys C 与SCr 均和CCr 有着显著的负相关性(CysC:r=-0.742,P<0.001;SCr:r=-0.503,P<0.001),而Cys C 的相关系数较高.ROC 曲线分析显示Cys C 的曲线下面积(AUC)值明显高于SCr(0.815 vs 0.643).结论 Cys C 较SCr 能更为准确反映肝脏手术患者术后的肾功能损害,常规监测该类患者的Cys C 水平,对有效预防该类患者术后肾功能不全,减少肝肾综合征的发生率具有积极意义.     

供、受体体质指数比值对公民逝世后器官捐献供肾移植后肾功能预后的影响

目的探讨供、受体体质指数(BMI)比值对公民逝世后器官捐献(DCD)供肾移植后肾功能的影响, 以指导公民逝世器官捐献供肾时受者的选择。方法回顾性分析2015年1月至2017年6月期间在郑州人民医院成功施行DCD肾移植的供、受者临床资料。依据供、受者BMI比值四分位数将受者分为3组:A组:BMI比值≤0.97, B组:BMI比值0.97～1.28, C组:BMI比值>1.28。比较3组术后1周、1个月、6个月、12个月及24个月血肌酐(SCr)、肾小球滤过率(GFR)的变化。结果术后1个月、6个月、12个月B组SCr值均低于A组与C组, 且组间差异有统计学意义(P <0.05);术后1个月、12个月B组GFR均高于A组与C组, 组间差异有统计学意义(P <0.05)。术后24个月时3组SCr、GFR比较差异无统计学意义。结论 B组受者肾功能恢复优于A组和C组。供、受者BMI比值介于0.97～1.28时移植肾功能及预后较好, 应作为选择受者的一个参考指标。     

Living Kidney Transplantation: Evaluation of Renal Function and Morphology of Potential Donors

The evaluation of potential living kidney donors requires an accurate study of renal function and morphology. The gold standard to assess renal function is the measurement of glomerular filtration rate (GFR). However, GFR is often estimated from serum creatinine (SCr), cystatin C (SCys), or creatinine clearance (CCr). Otherwise, GFR is predicted using formulas based on SCr or SCys. Ultrasound scanning evaluates morphology and dimensions, while scintigraphy provides information on morphofunctional symmetry of kidneys. The aim of this study in 79 potential donors was to assess the accuracy of the tests employed to estimate GFR and the utility of renal ultrasound and scintigraphy for morphofunctional evaluation of potential donors. GFR (clearance of ^99mTc-DTPA) was compared with estimates obtained with Cockcroft and Gault (CG-CCr) and Modification of Diet in Renal Disease (MDRD-GFR) formulas, and from SCys (Cys-GFR). The correlation with GFR was statistically significant for SCys and for all estimates, but not for SCr. CCr showed a poor agreement with GFR, with a large range of agreement and a marked and significant overestimation of GFR (33.8 mL/min). The accuracy of CG-CCr and MDRD-GFR as indicators of a GFR < 80 mL/min was better than that of Cys-GFR and CCr. However, their mean prediction errors versus GFR were relevant. Renal dimensions, particularly renal volume, showed a good correlation with GFR. The correlation was higher than that of all prediction equations. The direct measurement of GFR remains the reference method to assess renal function in potential kidney donors. The measurement of renal dimensions can provide useful information also on renal function.     

Echographic Renal Dimensions Can Predict Glomerular Filtration Rate of Potential Living Kidney Donors

In potential living kidney donors, glomerular filtration rate (GFR) is often evaluated from the creatinine clearance (Ccr) or is predicted using formulas based on serum creatinine (SCr) or cystatin C (SCys) concentration. Ultrasonography is used to evaluate renal structure and dimensions. The objective of the present study was to evaluate the possibility of estimation of GFR from echographic renal dimensions in 66 potential live kidney donors (46 women and 20 men; age range, 25-73 years). The GFR was measured as the renal clearance of technetium 99m diethylenetriamine pentaacetic acid. The GFR was also estimated from the SCr concentration using the Cockcroft-Gault (CG-Ccr) and Modification of Diet in Renal Disease (MDRD-GFR) formulas and from SCys (Cys-GFR). Renal diameters were measured using conventional gray-scale renal ultrasound to estimate total and parenchymal renal volume using ellipsoid formulas. The GFR was predicted from renal dimensions on the basis of their relationship to measured GFR. Estimates of GFR obtained using renal volume more close correlated with measured GFR than did CG-Ccr, MDRD-GFR, or Cys-GFR. The mean difference from measured GFR was null. The GFR estimated from renal volume demonstrated better agreement with measured GFR and a lower prediction error vs values from the other prediction formulas (18.3 vs 22-34 mL/min). The GFR values predicted from renal volume were quite accurate as indicators of GFR less than 80 mL/min. In potential living kidney donors, sonographic renal volume provided more accurate estimates of GFR, with lower prediction error, compared with formulas based on SCr or SCys.     

Assessment of renal function in renal transplant patients using cystatin C. A comparison to other renal function markers and estimates

To date, little evidence is available to define the role of cystatin C in patients with renal transplants. Thus, to assess, whether cystatin C (CysC) provides better information on renal function than other markers, CysC, creatinine clearance (CrCl), serum creatinine (SCr), beta2-microglobulin (beta2-M), and 125I-Iothalamate clearance were determined in 30 patients. Correlation and ROC curves were obtained and characteristics like sensitivity and specificity were calculated. Further, to evaluate the usefulness of these markers for monitoring, intraindividual coefficients of variation for CysC and SCr measurements were compared in 85 renal transplant patients. CysC correlated best with GFR, whereas SCr, CrCl and beta2-M all had lower correlation coefficients. CysC was superior to SCr, even when renal function equations of were used. The diagnostic accuracy of CysC was significantly better than SCr. but did not differ significantly from CrCl and beta2-M. Together, our data show that in patients with renal transplants, CysC has a similar diagnostic value as CrCl. However, it is superior to determinations of SCr. The intraindividual variation of CysC is significantly greater than that of SCr. This might be due to better ability of CysC to reflect temporary changes especially in mildly impaired GFR, most critical for early detection of rejection and other function impairment. In conclusion, CysC allows for easy and accurate assessment of renal function (GFR) in steady state renal transplant patients and is clearly superior to the commonly used serum creatinine.     

Kidney dimensions at sonography are correlated with glomerular filtration rate in renal transplant recipients and in kidney donors

The gold standard to assess renal function is the measurement of glomerular filtration rate (GFR). For practical reasons, renal function is often evaluated from serum creatinine (S Cr) or cystatin C (S Cys), and GFR is predicted from SCr. Ultrasound scanning of the kidneys is used only to evaluate renal morphology. The aim of this study was to evaluate the relationship between sonographic renal dimensions and GFR in renal transplant recipients and in kidney donors. GFR (urinary clearance of (99m)Tc-DTPA), S Cr, and S Cys were measured in 33 donors (28 females [F], 5 males [M]; SCr, 0.81-1.90 mg/dL) and 30 recipients (8 F, 22 M; SCr, 0.96-2.42 mg/dL). GFR was also predicted using the Cockcroft and Gault (CG) formula and with the simplified Modification of Diet in Renal Disease (MDRD) formula. Length, width, and depth of kidneys and renal sinus were measured using renal sonography. Among sonographic measurements, kidney length showed the best correlation with GFR. A closer correlation with GFR was found in donors (r = 0.639; P < .00007) than in recipients (r = 0.511; P < .005). In either case, the correlation of kidney length with GFR was greater than that of S Cr or S Cys, and similar to that of CG or MDRD GFR. Accuracy of kidney length as an indicator of GFR impairment was not statistically different from laboratory tests. Only in donors did CG show better accuracy. In conclusion, renal dimensions at sonography closely correlated with GFR. Thus, renal sonography can give information also on the function of the renal graft and of the remaining kidney of living donors.     

血清CysC、B2-MG评价慢性肾脏病患者早期肾功能损害

目的探讨血清半胱氨酸蛋白酶抑制剂C（CystC）、B2微球蛋白（胆-MG）在评价慢性肾脏病（CKD）患者早期肾功能损害中的临床价值。方法收集2008年2月至2009年1月问包头市中心医院。肾内科住院CKD患者116例,根据肾小球滤过率（GFR）,分为3组,即A组为肾功能正常组,GFR≥90ml·min-1。·（1．73m2）-1;B组为早期肾功能不全组,60ml·min-1。·（1．73m2）-1≤GFR〈90ml·min-1·（1．73m2）-1;C组为中晚期。肾功能不全组,GFR％60ml·min。·（1．73m2）～。测定不同肾功能时期CysC、132-MG、SCr、尿素氮（BUN）水平,各组间进行比较,并与GFR进行相关性比较,采用受试者工作特征曲线下面积,评价CysC、132-MG的可靠性。结果患者血清CysC、G2-MG、SCr、尿素氮（BUN）与GFR均呈显著相关（P〈0．01）,且以CysC与GFR的相关程度最密切,CysC、82-MG、SCr、尿素氮（BUN）受试者曲线下面积分别是0．989、0．983、0．877、0．873。结论CysC、胆-MG成为理想的反应GFR的内源性指标。通过联合检测血清CysC和B32-MG水平可以为评价GFR提供敏感、对早期诊断各种慢性肾脏病患者肾小球滤过功能的损害具有重要价值。     

Glomerular filtration rate estimation in renal transplant patients based on serum cystatin-C levels: comparison with other markers of glomerular filtration rate

PURPOSE: The assessment of glomerular filtration rate (GFR) is the most commonly used test of renal function. Cystatin-C, a cysteine protease inhibitor, which can be measured by light-scattering immunoassay, possesses many of the attributes required of the ideal GFR marker. Conversely, many endogenous markers that are widely used for the estimation of GFR such as serum creatinine (SCr) are not ideal. The present study was undertaken to evaluate the clinical application of serum cystatin-C (CysC) as a new marker of GFR in renal transplant patients. METHODS: Eighteen patients (9 men) were enrolled in the study (mean age: 46.35, range: 31-67 years) to measure serum CysC levels and compare them, with SCr, creatinine clearance (CCr), as well as the Cockcroft-Gault equation (CG) or the MDRD as indicator of GFR. Spearman's correlation coefficient was used to determine the relationship between CysC and other markers. RESULTS: There was a significant negative correlation between serum CysC and CCr (r = -0.768). Moreover, the CysC level was negatively correlated with CG (r = -0.854), positively correlated with SCr (r = 0.629), and negatively correlated with MDRD (r = -0.604). CONCLUSIONS: These results indicate that measurement of serum cystatin-C was useful and accurate to estimate GFR in renal transplant patients. The recent literature confirms our data although there are concerns about nonrenal influence on this test. Although serum CysC can generally be recommended as a marker for GFR, our study is still in progress seeking to validate the conclusions in a larger number of patients.     

ASSESSMENT OF RENAL FUNCTION IN RENAL TRANSPLANT PATIENTS USING CYSTATIN C. A COMPARISON TO OTHER RENAL FUNCTION MARKERS AND ESTIMATES

To date, little evidence is available to define the role of cystatin C in patients with renal transplants. Thus, to assess, whether cystatin C (CysC) provides better information on renal function than other markers, CysC, creatinine clearance (CrCl), serum creatinine (SCr), β₂-microglobulin (β₂-M), and ¹²⁵I-Iothalamate clearance were determined in 30 patients. Correlation and ROC curves were obtained and characteristics like sensitivityand specificity were calculated. Further, to evaluate the usefulness of these markers for monitoring, intraindividual coefficients of variation for CysC and SCr measurements were compared in 85 renal transplant patients. CysC correlated best with GFR, whereas SCr, CrCl and β₂-M all had lower correlation coefficients. CysC was superior to SCr, even when renal function equations of were used. The diagnostic accuracy of CysC was significantly better than SCr, but did not differ significantly from CrCl and β₂-M. Together, our data show that in patients with renal transplants, CysC has a similar diagnostic value as CrCl. However, it is superior to determinations of SCr. The intraindividual variation of CysC is significantly greater than that of SCr. This might be due to better ability of CysC to reffect temporary changes especially in mildly impaired GFR, most critical for early detection of rejection and other function impairment. In conclusion, CysC allows for easy and accurate assessment of renal function (GFR) in steady state renal transplant patients and is clearly superior to the commonly used serum creatinine.     

不同方法对肾功能评估的价值

目的探讨临床上常用的几种肾功能评估方法的相对准确性,寻求更为简便、快捷的肾功能评估方法。方法选择慢性肾脏病（CKD）患者80例,分别用^99mTc-DTPA肾动态显像法测定肾小球滤过率（GFR）,同时检测患者血肌酐（SCr）、血清胱抑素C（CysC）浓度,根据SCr分别用Cock-croft-Gault（C-G）方程和简化MDRD方程估算肾小球滤过率（分别为eGFR1、eGFR2）。按GFR值将患者分为4组,即A组：CKD1期;B组：CKD2期;C组：CKD3期;D组：CKD4期;排除CKD5期的患者。观察所有和各组患者eGFR1、eGFR2、SCr、CysC与GFR的相关性。结果总样本中,eGFR1、eGFR2与GFR呈正相关,SCr、CysC与GFR呈负相关（P〈0．01）。在各组中,A组：eGFR1、eGFR2、SCr与GFR之间均无明显相关性（P〉0．05）;而B、C、D组中eGFR1、eGFR2与GFR呈正相关（P〈0．01）,SCr与GFR呈负相关（P〈0．05）;CysC在A、B、C、D各组中均与GFR呈负相关（P〈0．01）。结论CKD2、3、4期患者eGFR1、eGFR2、SCr与GFR均有一定的相关性,但不论何期CKD患者,CysC均能准确反映其肾功能状况,且更加简便、快捷。