血清半胱氨酸蛋白酶抑制剂C对高血压患者早期肾损伤的诊断性能评价

目的 评价血清半胱氨酸蛋白酶抑制剂C(Cys C)对高血压患者早期肾损伤的诊断价值,为Cys C在临床的应用提供循证医学证据.方法 对318例原发性高血压并怀疑合并早期肾损伤的患者同时进行血清Cys C和99mTc-二乙三胺五醋酸(99mTc-DTPA)清除率的检测.以99mTc-DTPA清除率为诊断标准将318例患者...

Evaluation of the diagnosis value of serum cystatin C for early renal impairment in patients with hypertension

Objective To evaluate the clinical significance of serum cystatin C（Cys C） in early renal impairment in patients with hypertension,and provide the reference for Cys C in the clinical application.Methods 318 patients with primary hypertension and suspected early renal impairment were enrolled.Serum Cys C and the clearance of 99mTc-diethy lenetriaminepentaacetic acid（99mTc-DTPA） were determined.318 patients were classified into 2 groups according to the clearance of 99m Tc-DTPA（renal impairment group： 127 cases and control group： 191 cases）.The receiver operating characteristic（ROC） curve was used to confirm the cut-off value,and the sensitivity,specificity and Youden index were calculated.The accuracy of diagnosing the early renal impairment by serum Cys C was evaluated.The repeatability was assessed simultaneously,and the reliability was analyzed.Results According to the ROC curve,the best cut-off value of diagnosing patients with primary hypertension and early renal impairment was 1.26 mg/L.The sensitivity and specificity were 84.3% and 79.1%.The positive and negative predictive values were 72.8% and 88.3% respectively.The positive and negative likelihood ratios were 4.03 and 0.20.The rate of missed diagnosis was 15.7%,and the misdiagnosis rate was 20.9%.The total coincidence and Youden index were 81.1% and 0.63.The area under ROC curve 95% confidence interval（CI）] was 0.855（0.814-0.896）.When the daily mean of Cys C was 1.21 and 1.67 mg/L,the within-run coefficient of varication（CV） were 2.9% and 2.7%,and the between-run CV were 3.6% and 3.3%.The daytime CV were 4.1% and 3.8%,and the total CV were 7.0% and 6.4%.Conclusions Serum Cys C has significant diagnosis value for early renal impairment in primary hypertension patients,and it is suitable for early screening.