半胱氨酸蛋白酶抑制剂C联合肌酐评估慢性肾脏病肾小球滤过率的准确性

目的 验证2008年美国CKD-EPI基于半胱氨酸蛋白酶抑制剂C(cystatinc)开发的肾小球滤过率(GFR)评估方程在中国慢性肾脏病(CKD)患者的适用性.方法 选择2008年12月至2009年4月中山大学附属第二医院68例非透析CKD患者,用体表面积标准化Cockcroft-Ganh方程、简化MDRD方程、改良后简化MDRD方程、肾动态显像以及2008年美同CKD-EPI基于eystatin C开发的3条GFR评估方程计算的GFR(分别为cGFR、aGFR、mGFR、gGFR、CyslGFR、Cys2GFR、Cys3GFR),与双血浆法99mTc-DTPA血浆清除率测定的GFR(即tGFR)进行比较分析.结果 Pearson相关分析显示,7种方法GFR估计值与tGFR明显相关,相关系数从大到小依次为Cys3GFR(0.93)、gGFR(0.91)、mGFR(0.89)、Cys2GFR(0.88)、CyslGFR(0.85)、cGFR(0.85)、aGFR(0.83).在准确性比较中,Cys3GFR较aGFR、CysIGFR准确性高.Bland.Altman分析显示Cys3GFR估计值与tGFR的一致性最好,其一致性限度未超过事先规定的专业界值.线性同归结果显示mGFR偏差最小,精确度最高.结论 cystatin C联合肌酐并包括人口统计学参数的方程(Cys3GFR)应用于中国CKD患者准确性较高,与tGFR相关性和一致性最好.且优于仅包括cystatin C GFR估评方程(CyslGFR)、Cockcrofi-Gauh方程、简化MDRD方程.

Accuracy with glomerular filtration rate estimation in chronic kidney disease using cystatin C combined with creatinine

Objective To verify the adaptability of CKD-EPI equation developed based on cystatin C in America in 2008 among Chinese patients with chronic kidney disease (CKD).Methods Between December 2008 and April 2009, 68 non - dialysis CKD patients were recruited and calculated for their glomerular filtration rates(GFRs) by Cockcroft-Gault equation, simplified MDRD equation, modified MDRD equation and gates method with 99mTc-DTPA (cGFR, aGFR, mGFR, gGFR) and three CKD-EPI estimating equations developed based on cystatin C (CyslGFR, Cys2GFR, Cys3GFR).All the results above were then compared and analyzed with tGFR determined by double plasma sample method of GFR with 99mTc-DTPA.Results Pearson analysis demonstrated that seven estimated GFRs (cGFR, aGFR, mGFR, gGFR,cyslGFR, cys2GFR, cys3GFR) were significantly correlated with tGFR, with Cys3GFR showing the highest correlation coefficient (0.93) , followed by gGFR (0.91) , mGFR (0.89) , Cys2GFR (0.88) , CyslGFR (0.85), cGFR(0.85), and aGFR(0.83).Cys3GFR yielded results that were more accurate than did aGFR or CyslGFR.Bland-Altman analysis demonstrated that Cys3GFR had the best consistency with tGFR which did not exceed the predetermined limits.The outcome of linear regression showed that the modified MDRD equation had the least deviation and the highest precision.Conclusion In Chinese population, the third CKD-EPI equation (Cys3GFR) including cystatin, creatinine and demographic statistics has favorably greater accuracy, and best consistency and correlation with tGFR, as compared with the first CKD-EPI equation based on cystatin C alone, Cockcroft-Gault equation or simplified MDRD equation.