血清胱抑素C判断移植肾功能的研究

Assessment of renal function in renal transplant patients using cystatin C.

目的:探讨血清胱抑素C(cystatinC)在监测移植肾功能中的价值。方法:23例肾移植患者采用颗粒强透免疫比浊法测定血清cystatinC,同时采用同位素锝[99mTc]二乙烯三胺五乙酸(di ethylenetriaminepentaaceticacid,DTPA)肾动态显像测定移植肾小球滤过率(glomerularfiltrationrate,GFR),测定血清肌酐(serumcreatinine,Scr)及用公式计算内生肌酐清除率(endogenouscreatinineclear ance,Ccr)。测定34名正常健康者作为对照。采用SPSS11软件分析各指标相关性及特异度、灵敏度。结果:cystatinC、Scr、Ccr与GFR的相关性分别是r1=-0.872(P<0.001)、r2=-0.687(P<0.001)、r3=0.634(P=0.002)。在判断GFR是否受损时,cystatinC的特异度和灵敏度(100%,94.1%)明显高于Scr(75.0%,70.6%)和Ccr(75.0%,88.2%);在判断肾功能轻度受损时,cystatinC的特异度和灵敏度(100%,88.9%)也比Scr(83.3%,66.7%)和Ccr(83.3%,77.8%)高;尽管在判断肾功能重度受损时,cystatinC的灵敏度(75%)不如Scr(100%),但特异度(100%)仍高于Ccr(88.2%)。结论:cystatinC能准确判断移植肾功能,优于Scr和Ccr,具有临床应用价值。

Objective: To determine the diagnostic value of cystatin C in renal transplant patients.Methods:23 renal transplant patients and 34 controls were included in this study, Glomerular filtration rate was measured by an single injection of ^(99m)Tc-DTPA,Cystatin C was determined using particle-enhanced turbimetric immunoassay(PETIA).Serum creatinine (Scr) was (examined) during routine clinic visit.Creatinine clearance (Ccr)was calculated by the Ccockcroft-Gault formula.Statistical analysis was performed by the software SPSS 11,Pearson correlation coefficients were calculated and ROC plots were generated to show sensitivity and specificity for cystatin C,Scr and Ccr. Results:There were significant correlations among cystatin C(r 1=-0.872,P<0.001),Scr(r 2=-0.687,P<0.001),Ccr(r 3=0.634,P=0.002)and GFR.ROC analysis for the diagnostic accuracy was performed, Specificity and sensitivity for cystatin C,Scr,Ccr were 100% and 94.1%, 75.0% and 70.6%,75.0% and 88.2 %for the diagnosis of impaired GFR; were 100% and 88.9%,83.3% and 66.7%,83.3% and 77.8% in mild impaired GFR;were 100% and 75.0%,100% and 100%,88.2% and 75.0% in severe impaired GFR respectively.Conclusion:Cystatin C is an accurate marker of glomerular filtration rate and presents advantage over Scr, Ccr after renal transplantation.