血清胱抑素-C和肾小球滤过方程在慢性肾脏病患者临床应用的实用性探讨

目的探讨血清胱抑素-C（Cys-C）和各种肾小球滤过方程在诊断慢性肾脏病（CKD）患者中的临床意义。方法双血浆法^99mTc-DTPA清除率测定肾小球滤过率（rGFR）作为标准,MDRD方程7、简化MDRD方程、简化改良MDRD方程、Cockcroft-Gault公式计算的GFR及Cys-C与^99mTc-DTPA清除率测定肾小球滤过率做比较,观察它们的相关性。结果在CKD1、2期,简化的MDRD方程和Cockcroft-Gault公式明显低估了GFR,简化的MDRD方程低估GFR的程度高于Cockcroft-Gault公式;改良简化MDRD方程,其相关系数为0.812、0.867,显示了改良简化MDRD方程评估CKD患者早期肾功能的变化具有优势;在CKD3期,改良简化MDRD方程与rGFR比较,其相关性最强。在CKD4、5期,各种方程均能很好地评估GFR。结论肾功能轻中度损害时,使用改良简化MDRD方程和Cystatin-C预测肾小球滤过率,肾功能重度损害时,可以根据当地医院的条件选用目前的各种方程评估GFR。

Pratical value of serum cystatin c and GFR equation for patients with chronic kidney disease

Objective To study the practical value of Serum Cystatin C（Cys-C）（μg/ml）and various kinds of equations of glomerular filtration rate（GFR）for patients with chronic Kidney Disease.Methods Used ^99mTcdiethylene triamine pentaacetic acid（^99mTc-DTPA）clearance by dual plasma sampling methods as reference GFR（rGFR）ml/min.1.73 m^2.Compared values of various kinds of GFR equations with rGFR ml/min.1.73 m^2.The correlation between rGFR and eGFR（ml/min.1.73 m^2） were observed.Results Simplified equation of MDRD and Cockcroft-Gault formula underestimate GFR（ml/min.1.73 m^2）during the stage 1and 2 of CKD.The degree of underestimating of Simplified equation of MDRD was higher than Cockcroft-Gault formula.The coefficient of modified abbreviated MDRD equation was 0.812 and 0.867.It was showed the suoeriority to estimating original variance of renal function.During the stage 3 of CKD,it was strongest correlation between modified abbreviated MDRD equation and rGFR（ml/min.1.73 m^2）.It was practical of all kinds of equations during the stage 4 and 5 of CKD.Conclusion When renal function is mild or moderate damaged,we advice to estimate GFR（ml/min.1.73 m^2）using Cys-C（μg/ml）and modified abbreviated MDRD equation.While renal function is severe damaged,we advise to use all kinds of equations to evaluate GFR（ml/min.1.73 m^2）.