Serum tumour markers in patients with chronic kidney disease

OBJECTIVE. Tumour markers are widely used for monitoring cancer patients and for screening certain tumours. It has recently been shown that the concentrations of some tumour markers are higher in patients with chronic kidney disease (CKD) than in healthy subjects. We analysed the influence of renal function and hemodialysis treatment on the serum levels of CA19-9, CA125, alpha fetoprotein (AFP), CA15.3, CA72.4, CYFRA 21-1, neuron-specific enolase (NSE) and squamous cell carcinoma antigen (SCC-Ag). MATERIAL AND METHODS: 232 non-dialysis patients with CKD and 37 uraemic patients treated with maintenance hemodialysis were enrolled in this study. The nondialysis patients were divided into three groups depending on their creatinine clearance (Ccr) levels: group 1 = Ccr < or =25 mL/min; group 2 = 25.1-49.9 mL/min; group 3 = Ccr > or =50 mL/min. For comparison, we chose 37 non-dialysis patients with similar Ccr, age and same gender as controls. RESULTS: The serum concentrations of CA19-9, CA125 (male), CYFRA 21-1, NSE and SCC-Ag correlated negatively with Ccr, while there were no significant differences in the concentrations of CA125 (female), AFP, CA15.3, CA72.4. The serum levels of CA19-9, CA125, AFP, CA15.3, CA72.4, CYFRA 21-1, NSE and SCC-Ag showed no differences between hemodialysis patients and non-dialysis controls (p > 0.017). CONCLUSIONS: The increase in the serum levels of CA19-9, CA125 (in males), CYFRA 21-1, NSE and SCC-Ag in patients with CKD affects the specificity of these markers in the diagnosis of cancer. Hemodialysis does not affect the serum levels of CA19-9, CA125, AFP, CA15.3, CA72.4, CYFRA 21-1, NSE and SCC-Ag.     

慢性肾衰竭维持性血液透析患者血清瘦素水平及其意义

目的：探讨慢性肾衰竭维持性血液透析患者的血清瘦素水平及其与残余肾功能、人体构成和营养状况的关系.方法：分别采用放射免疫分析技术、生物电阻抗技术和常规生化方法测定68例慢性肾衰竭维持性血透患者的血清瘦素水平、残余肾功能、人体构成和营养相关指标.结果：慢性肾衰竭维持性血透患者血清瘦素水平显著高于对照组（P〈0.01）;瘦素水平与体重指数和脂肪百分比呈正相关,与去脂体重呈负相关（P均〈0.01）,与内生肌酐清除率、血清肌酐、尿素氮、白蛋白、胆固醇、血红蛋白相关性无统计学意义（P均〉0.05）.结论：慢性肾衰竭维持性血透患者存在高瘦素血症, 血清瘦素水平可以作为评价机体脂肪含量的营养指标,其在终末期慢性肾衰竭血透患者蛋白质营养不良中未发挥显著作用.     

慢性肾脏病流行病合作工作组方程和肌酐全年龄段方程用于成人慢性肾脏病

目的 比较慢性肾脏病流行病合作组方程(CKD-EPI)和肌酐全年龄段方程(FAS)评估慢性肾脏病(CKD)患者肾小球滤过率(GFR)的价值.方法 回顾性分析393例CKD,以99Tcm-DTPA肾动态显像法所测GFR(Tc-GFR)为金标准,采用3个CKD-EPI方程及3个FAS方程,分别为流行病学-血肌酐(EPI-S...     

慢性肾脏病患者不同肾损害时期血清胱抑素C的水平探讨

目的检测慢性肾脏病（CKD）患者血清中半胱氨酸蛋白酶抑制剂胱抑素C（Cystatin C）水平,探讨CKD不同肾损害期血清Cystatin C水平的变化情况。方法根据临床分期将研究对象分为CKDⅠ、Ⅱ、Ⅲ、Ⅳ、Ⅴ期组,采用胶乳增强免疫透射比浊法检测各组患者血清Cystatin C水平,同时测定血清肌酐（SCr）及内生肌酐清除率（Ccr）,并与健康对照组比较。结果CKD患者其他各期血清Cystatin C及Ccr与Ⅰ期组比较差异有统计学意义（P〈0.01）;各组患者血清Cystatin C水平与健康对照组比较差异有统计学意义（P〈0.01）;相关分析显示,血清Cystatin C与SCr之间呈高度正相关（r=0.781,P〈0.01）,与Ccr之间呈高度负相关（r=-0.815,P〈0.01）。在肾功能损害早期血清CystatinC改变较SCr更敏感（P〈0.01）。结论CystatinC是一种比SCr更好的反映肾小球滤过功能的指标,能反映CKD不同阶段中肾脏滤过功能的损害程度。     

Predictive performance of serum digoxin concentration in patients with congestive heart failure by a hyperbolic model based on creatinine clearance

OBJECTIVES: To formulate a simple equation for determining the daily dose requirements of digoxin by inclusion of creatinine clearance (Ccr) values as an explanatory variable. METHODS: We included 235 routine monitoring and clinical laboratory test data (steady-state serum digoxin concentration and Ccr values), obtained from hospitalized patients receiving digoxin for treatment of congestive heart failure. The 107 data sets were fitted to a hyperbolic model to account for the relation between the ratio of serum digoxin level to the daily dose (L/D) and the Ccr values determined by six methods. Their correlation coefficients (r) were computed by non-linear regression analysis. To evaluate the validity of the best-fitting model, the predictive performance of the L/D ratios was compared with those given by seven reference models previously published, using another 128 data sets. RESULTS: The hyperbolic model involving the Ccr values estimated by Cockcroft and Gault's equation showed the closest correlation (r = 0.81) between the actual and estimated Ccr values. Mean prediction error (ME), a measure of bias, of the L/D ratio (0.018 ng/mL) was almost negligible when other data were fitted to the proposed model, and this ME value proved to be much smaller than those calculated from the previously published prediction models. Mean absolute prediction error, a measure of precision, by the proposed model was also satisfactory for prediction. CONCLUSION: The newly developed model provided good predictive performance of serum digoxin level. Taking simplicity in practical use into account, the clinical application of the proposed model will allow for accurate and rapid determination of the initial maintenance dosing regimen of digoxin based on the individual Ccr value, without actual measurement of its serum concentration.     

CystatinC在评价CKD患者肾小球滤过功能中的作用

目的比较血清胱抑素c（CystatfnC）、血清肌酐（Scr）、肌酐清除率（Ccr）在慢性肾病（CKD）患者各期与简化MDRD方程估算的肾小球滤过率（eGFR）的符合率。方法血清胱抑索c采用免疫透射比浊法测定,scr和尿肌酐采用酶法测定。估算的eGFR采用简化MDRD方程进行计算。CKD患者临床分期采用美国NFK—K／DOQI指南分期。结果109例CKD患者各期CystatinC、Scr随eGFR的降低而逐渐升高,Ccr随eGFR的降低而逐渐降低,三者在各期间水平的差异均有统计学意义（P〈0．05）。当eGFR≤29ml／min时。CystatinC、Scr、Ccr均为100％的异常,CystatinC、Scr平均水平是参考范围上限的5倍左右,ccr下降4—6倍,三者呈平行性改变;在eGFR30—59ml／min组,CystatinC、Scr、Ccr的平均水平分别为2．54mg／L、144．6gmol／L和50．6ml／min,异常率分别为95％、83％和85％,三者之间异常率的差异无统计学意义（P〉0．05）;在eGFR60．89ml／min组,cvs—tatinC、Ccr异常率为84％和63％,Scr异常率为5．9％,三者之间异常率的差异具有统计学意义（P〈0．05）;在eGFR≥90m1／min组,CystatinC、Ccr异常率为5l％和40％,Scr异常率为l％。结论eGFR〈59ml／min时,CystatlnC、scr、Ccr的结果一致好,与诂算的结果符合率高,基本可以诊断肾小球滤过功能中度下降;当eGFR在60。89ml／min时,CystatinC、Ccr可以检出2／3患者肾小球滤过率的异常,且CystatinC更敏感,而scr不能反应肾小球滤过功能的下降;当eGFR≥90ml／min时,MDRD方程过高估计eGFR值,需检测CystafinC和Ccr以及时发现eGFR的下降。     

结肠透析治疗60例慢性肾功能衰竭的疗效分析

目的 观察结肠透析治疗慢性肾功能衰竭的疗效.方法 将120例慢性肾功能衰竭患者随机分为2组,每组各60例,A组为结肠透析组,在常规治疗的基础上应用结肠透析机治疗;B组为常规治疗组,给予慢性肾功能衰竭的常规治疗.观察期为4周,观察血肌酐、尿素氮和24 h尿蛋白定量,以血肌酐的变化判断透析的疗效.结果 A、B组均可明显降低慢性肾功能衰竭患者的血肌酐水平,血肌酐分别由(363.97±82.34)μmol/L降为(280.87±87.52)μmol/L和(371.73±87.46)μmol/L降为(339.90±68.59)μmol/L,A组的治疗效果明显优于B组(P＜0.05);对A组不同期的患者进行疗效对比,发现肾功能代偿期和失代偿期的疗效明显好于肾功能衰竭期,而前两者之间的疗效差别不明显.结论 结肠透析治疗慢性肾功能衰竭疗效确切,尤其对血肌酐＜443 μmol/L的患者能达到更好的治疗效果.     

Effects of fluvastatin treatment on lipid profile, C-reactive protein trend, and renal function in dyslipidemic patients with chronic renal failure

The purpose of this trial was to evaluate the effects of fluvastatin on the lipid profile and on renal function, as measured by creatinine clearance, in dyslipidemic patients with chronic renal failure. In this 8-month prospective, open-label, randomized, parallel-group trial, 130 patients (70 men and 60 women), after a 2-month washout period following previous lipid-lowering treatments, were randomly assigned to fluvastatin XL 80 mg given once daily (80 patients) or to standard treatment (50 patients). Mean total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglyceride values after 3 and 6 months of treatment with fluvastatin showed statistically significant improvement compared with standard treatment. Improved renal function, as measured by creatinine clearance, was observed at the end of the 6-month treatment period in approximately 65% of patients treated with fluvastatin. The increase in creatinine clearance consistently reached 10% to 15% of baseline values. A statistically significant reduction in C-reactive protein (CRP) over baseline values was observed in approximately 75% of patients treated with fluvastatin. Furthermore, mean values of CRP for the fluvastatin standard treatment groups, respectively, were 6.78 and 10.19 at 3 months and 4.47 and 11 at 6 months. Both treatments were well tolerated. No major adverse events were noted. Results of this study suggest that fluvastatin treatment in patients with chronic renal failure is effective in improving the lipid profile, and it demonstrates good safety and tolerability. Furthermore, fluvastatin may contribute to improved nephroprotection in this patient population.     

肾小管标记物测定在慢性肾功能不全病人中的结果探讨

目的通过测定肾小管标记物THP、RBP、α1-MG、β2-MG,NAG、IL-6、ET-1及肾小管功能的项目(CH2O),判断肾功能不全病人的肾小管-间质损伤及炎症程度。方法应用放射免疫法测定IL-6、ET-1、THP、RBP、α1-MG、2β-MG,用ELISA沾测定RBP,用比色法测定NAG,用物理学方法测定CH2O。结果ET-l、RBP、2β-MG、CH2O的结果均是根据CRF病情分型逐渐上升,THP、IL-6是逐渐下降而1α-MG、NAG在CRF-Ⅱ以后均比CRF-I高但CRF-Ⅱ、Ⅲ、Ⅳ之间有高有低没有明显差异(p>0.05)。结论通过监测多种肾小管标记物及细胞因子可以对肾功能不全病人的肾间质损伤及炎性状态起到很好的诊断,对治疗有一定的指导作用。     

早、中期慢性肾功能衰竭的危险因素分析

目的:调查和分析早、中期慢性肾脏疾病(CKD)住院患者高危因素,为早期干预、延缓慢性肾功能衰竭(CRF)进程提供依据。方法:采用流行病学问卷调查方法,对我院各临床科室的肾小球滤过率(GFR)≥30ml/(min·1.73m2)住院患者进行调查,并将患者分成早、中期CRF组和非CRF组。结果:资料完整的病例共661例,其中非CRF组有330例;CRF组331例。相关的分析结果显示:高血糖、高血压、高血脂、心血管疾病、脑血管意外、高尿酸血症、蛋白尿、贫血和年龄与早、中期CRF有关联(P<0.05)。对所有因素进行Logistic回归分析、四格表的比值比(oddsratio,OR)和相对危险度分析,结果显示蛋白尿、高尿酸、贫血、年龄、高血压、高血脂的OR值分别为7.648、4.589、3.118、1.939、1.889和1.450;高尿酸血症和蛋白尿的OR值为7.578。原发性肾小球疾病发生CRF的可能危险因素依次为贫血、高尿酸血症、高血压、高血脂、高血糖、蛋白尿。结论:早、中期CRF高危因素中,主要为高尿酸血症,其次为蛋白尿、贫血、高血压、高血脂等;高尿酸合并蛋白尿者发生CRF的危险性最大。     

Effect of an exercise program with blood flow restriction on the muscular strength of patients with chronic kidney disease: A randomized clinical trial

IntroductionAn arteriovenous fistula (AVF) is performed in chronic kidney disease (CKD) patients before hemodialysis, who may benefit from exercise. The aim of this study was to evaluate the effect of an exercise program associated with partial limb blood flow restriction (BFR) on handgrip strength (HGS) and forearm circumference of CKD patients.MethodsA total of 26 patients with CKD were randomized to the BFR experimental group (EG, n = 12) and to the non-BFR control group (CG, n = 14) prior to AVF, and underwent isometric exercises for the flexor muscles of the fingers and elbow where the AVF will be performed.ResultsThere were no differences at the end of eight weeks of training between the EG and CG groups [F (1.23) = 0.03, p = 0.96] regarding the HGS and the forearm circumference [F (1.23) = 0.90, p = 0.76], however muscle strength [F (1.23) = 189.84, p < 0.001] and forearm circumference [F (1.23) = 540.90, p < 0.001] improved between baseline and the results at the end of the program.ConclusionPartial BFR training was not superior to the CG for the outcomes evaluated in this study. Further studies should be conducted so that an indication of an exercise protocol for the evaluated outcomes is prescribed in order to be effectively offered in clinical practice.     

Serum cystatin C assay for the detection of early renal impairment in diabetic patients

The ability to assess renal function in diabetes patients rapidly and early is of major importance. This study was designed to determine whether cystatin C can replace serum creatinine as the screening marker for reduced glomerular filtration rate (GFR) in type 2 diabetes patients. The study was performed on 51 type 2 diabetic patients. GFR was estimated by the plasma clearance of (99m)Tc-DTPA. The correlation between (99m)Tc-DTPA clearance and levels of serum cystatin C, serum creatinine, and creatinine clearance was determined. Sensitivity and specificity for the diagnosis of renal impairment (defined as GFR<68 ml/min) were calculated by a receiver operating characteristic (ROC) curve for serum cystatin C, serum creatinine, and creatinine clearance. The correlation coefficients with (99m)Tc-DTPA clearance were -0.744 for serum cystatin C, -0.658 for serum creatinine, and +0.625 for creatinine clearance (P<0.001). With a cutoff value of 68 mL/min, the area under the ROC curve (AUC) was 0.891 for cystatin C, 0.77 for creatinine, and 0.753 for creatinine clearance. The AUC was statistically different between serum cystatin C and creatinine clearance (P<0.05). The ROC plot indicates that cystatin C is superior to serum creatinine and creatinine clearance for detecting impaired GFR. Serum cystatin C appropriately reflects GFR in diabetes, and is more efficacious than serum creatinine and creatinine clearance in detecting reduced GFR in type 2 diabetes patients.     

高通量血液透析对慢性肾衰竭血清晚期糖基化终产物的影响

目的：探讨慢性肾功能衰竭患者血清晚期糖基化终产物水平的变化及高通量血透对其清除效果。方法：应用竞争性ELISA法检测慢性肾功能衰竭患者（非血液透析组及血液透析组）血清晚期糖基化终产物水平。结果：慢性肾功能衰竭患者无论血液透析与否，血清晚期糖基化终产物均明显高于健康组（P均〈0．01），非血液透析与血液透析组晚期糖基化终产物水平差异无显著性（P〉0．05），晚期糖基化终产物水平与血Cr呈明显正相关（r=0．5974，P〈0．01），与血糖无相关性；常规血液透析组，透析前后血清晚期糖基化终产物水平差异无统计学意义（P〉0．05），而高通量血液透析组透析后血清晚期糖基化终产物水平明显降低（P〈0．01）。结论：慢性肾功能衰竭时，因肾功能受损致晚期糖基化终产物清除障碍，是血清晚期糖基化终产物水平升高的主要原因，高通量血液透析可以有效清除血清晚期糖基化终产物。     

123例慢性肾脏病基础上急性肾衰竭临床分析

目的了解慢性肾脏病基础上急性肾衰竭（A／C）发病情况及临床特点。方法回顾性分析本科1995年1月至2008年12月临床诊断慢性肾脏病基础上急性肾衰竭（ARF）病例发病率、病因、与基础肾脏病关系及预后影响因素。结果123例符合选择标准,占同期急性肾衰竭病例数65．5％;A／C常见病因分别为药物性（主要为抗生素、NSAIDs和ACEI）56例、肾前性因素31例、狼疮性肾炎活动8例,其中药物性最常见,超过1／3;糖尿病肾病（DN）患者是发生A／C的主要人群,123例中有43例（占35．0％）;63例需血液透析,28例患者血肌酐恢复到原有水平,38例转为维持性透析,病死率3．3％;多因素回归分析示老年患者、高血压、需要接受血液透析、糖尿病,提示预后不良。结论A／C是急性肾衰竭主要病因,药物性最常见。A／C治疗关键在于预防。应重视糖尿病肾病诊治。     

慢性肾功能衰竭行维持性血液透析患者生活质量与社会支持的相关性调查分析

目的探讨慢性肾功能衰竭行维持性血液透析患者生活质量与社会支持的相关性。方法调查92例慢性肾衰竭行维持性血液透析患者的社会支持情况,并与正常对照组进行比较,分析慢性肾衰竭行维持性血液透析患者生活质量与社会支持的相关性。结果慢性肾衰竭行维持性血液透析患者的社会支持与正常对照组比较,差异有显著意义（P〈0.05）;生活质量与其社会支持呈正相关（r=0.684,P〈0.05）。结论慢性肾衰竭行维持性血液透析患者得到比正常人高的社会支持,其生活质量与社会支持密切相关,护理过程中重视社会支持可改善护理效果,提高慢性肾衰竭行维持性血液透析患者的生活质量。     

血浆hs-CRP水平与慢性肾功能不全患者肌酐清除率的关系

目的评估血浆超敏C-反应蛋白(hs-CRP)水平与慢性肾功能不全患者肌酐清除率的关系。方法收集98例慢性肾功能不全患者以及25例健康人群作为对照组,评估所有入选者血浆尿素氮、肌酐、清蛋白、hs-CRP水平,采用MDRD公式计算肌酐清除率;同时采用Pearson相关分析血浆hs-CRP水平与肌酐清除率关系。结果 (1)随着慢性肾脏病分期的进展,慢性肾功能不全患者血浆尿素氮、肌酐和hs-CRP水平呈逐渐升高,而血浆清蛋白水平和肌酐清除率则逐渐降低(P<0.05);(2)Pearson相关性分析提示,慢性肾功能不全患者血浆hs-CRP水平与肌酐清除率呈负相关(r=-0.816,P<0.05),对于肾功能正常对照组,其血浆hs-CRP水平与肌酐清除率无明显相关(r=-0.366,P=0.164)。结论对于慢性肾功能不全患者,其血浆hs-CRP水平与内生肌酐清除率具有较好相关性,检测血浆hs-CRP水平联合其他指标能够更好地评估慢性肾功能不全患者总体状况。     

Applicability of estimated glomerular filtration rate in stratifying chronic kidney disease

Objective. The aim of this audit was to evaluate the degree of glomerular filtration rate (GFR) among inpatients and outpatients in a District General Hospital, with special attention given to laboratory testing and impact on health delivery. Background. UK Chronic Kidney Disease guidelines recommend that investigation of renal function should be accompanied by an estimation of GFR (eGFR) in order to identify and manage patients with chronic kidney disease (CKD). The estimated GFR forms the basis for classification of CKD and appropriate action plans for patient management and follow‐up. Method. A retrospective audit of 8160 results from a predominantly British Caucasian population was carried out; extracting creatinine results from two isolated months in years 2001 and 2004. The estimated GFR (eGFR) was calculated using the MDRD formula. The data were classified according to demography, serum creatinine and eGFR. Patients from the 2001 database were classified according to eGFR and those with a value of <60?mL/min/1.73m² were followed up in 2004. Results. The difference in eGFR between the men and women was significantly different with medians (confidence intervals) of 80.1 (41–109) and 64.4 (30–84.6) (p<0.0001), respectively. There was an inverse association between age and eGFR in both genders (p<0.0001), with a decrease in eGFR of around 7?% for each decade increase in age. 1926 patients (24?%) of results studied had eGFR <60?mL/min, of whom 64?% were females and 36?% males. Follow‐up of patients with eGFR<60?mL/min from 2001 showed that 4?% progressed to stages 4 and 5 CKD. Conclusion. eGFR is inversely associated with increasing age and female gender. MDRD derived eGFR fails to completely compensate for age and gender variations and thus different action limits may be required. Small but significant numbers of patients progressed to stages 4 and 5 CKD. Additional clarity in describing “progressive fall in eGFR” in the guidelines would improve identification of the population most at risk.     

CKD-EPI 开发方程在评价慢性肾脏病患者病情中的作用

目的：分析评价美国慢性肾脏病（CKD）流行病合作工作组（CKD‐EPI）开发方程在 CKD 患者病情评估中的作用。方法2012年1月至2014年4月湖北省中医院肾病门诊260例 CKD 患者,用 CKD‐EPI 开发方程计算肾小球滤过率（GFR）（EPI‐GFR）,同 CKD 患者血肌酐（Cr）、尿酸（UA）、清蛋白（ALB）、钙（Ca）、磷（P）、胱抑素 C（CysC）、24 h 尿蛋白（UP）、血红蛋白（Hb）等生化指标比较,并与简化肾脏病饮食改良（MDRD）方差计算的 eGFR（简化‐GFR）和中国人校正的 MDRD 方程计算的 eGFR（校正‐GFR）进行比较。结果 EPI‐GFR 与 Cr 、UA 、CysC 、P 及24 h UP 呈显著负相关（P ＜0．05）,与 Hb 差异有统计学意义（P＜0．05）,呈显著正相关,随着病程进展,GFR 逐渐下降,患者贫血也逐渐加重,ALB 、Ca 出现不同程度的下降。简化‐GFR 和校正‐GFR 与 EPI‐GFR 的相关性均较好（r 分别为0．997和0．995,P ＜0．05）。 EPI‐GFR 比简化‐GFR 平均值高约0．49 mL／（min ×1．73 m2）,比校正‐GFR 平均值低约0．81 mL ／（min ×1．73 m2）。结论以 CKD‐EPI 开发方程计算 GFR ,对 CKD 患者肾功能的损伤评价有较好相关性及较好的预测能力,测定简便易行,可弥补其他评估方程导致的过度治疗或降低分级诊断的缺陷,为 CKD分期提供了极大便利,可在临床常规肾功能检测中推广使用。     

采用连续性肾脏替代与间歇性血液透析治疗重症急性肾衰竭的临床效果对比研究

目的回顾性地将重症急性肾功能衰竭(ARF)情况下所使用的连续性肾脏替代疗法(CRRT)与间歇性血液透析疗法(IHD)进行临床治疗效果对比。方法以自2011年1月至2012年5月接受重症急性肾功能衰竭的104例患者为对象,按照治疗方法的不同分别归入C组(43例)和I组(61例)中,其中C组患者均采用连续性肾脏替代疗法进行重症急性肾功能衰竭治疗,I组患者均采用间歇性血液透析疗法接受治疗。经治疗12个月后,观察尿素氮(BUN)、血清肌酐(Scr)、内生肌酐(Ccr)等指标以及最终存活率。结果根据各类临床资料显示,C组患者在接受治疗后BUN降至(19.32±4.54)mmol/L,Scr降至(410.37±138.41)μmol/L,Ccr升至(23.78±10.96)μmol/L,P0.05;I组患者BUN降至(26.03±3.59)mmol/L,Scr降至(423.41±152.84)μmol/L,Ccr升至(14.82±8.36)μmol/L,P0.05;随访调查对象存活率为C组88.4%、I组51.6%。结论治疗重症急性型肾功能衰竭,CRRT不仅效果好,且存活率高,临床效果明显优于IHD。     

血清胱抑素C在早期慢性肾脏病中的临床应用评价

目的探讨检测血清胱抑素C(Cys C)水平在慢性肾脏病(CKD)患者不同肾损害期作为早期敏感标志物临床诊断的应用价值。方法根据临床分期将研究对象分为CKDⅠ、Ⅱ、Ⅲ、Ⅳ、Ⅴ期组,采用乳胶增强免疫透射比浊法测定血清Cys C,同时测定血清肌酐(Scr)、尿素氮、内生肌酐清除率(Ccr)。结果血清Cys C在CKDⅠ、Ⅱ、Ⅲ、Ⅳ、Ⅴ期组分别为(1.04±0.49)、(1.99±0.76)、(6.49±1.92)、(9.15±3.02)、(12.15±5.10)mg/L与健康对照组的(0.81±0.10)mg/L比较,差异有统计学意义(P<0.01);相关分析显示,血清Cys C与Scr呈正相关,与Ccr呈负相关。在肾损害早期Cys C改变比Scr更敏感,差异有统计学意义(P<0.01)。结论血清Cys C是反映肾脏早期损害的敏感指标,由于方法简单易于标准化,可以替代操作繁琐的内生肌酐清除率来判断肾小球滤过功能。