血清半胱氨酸蛋白酶抑制剂C在评价高龄慢性肾脏病患者肾小球滤过功能中的作用

The potential role of Cystatin C for glomerular filtration rate of senile patients with chronic kidney disease

目的探讨血清半胱氨酸蛋白酶抑制剂C(Cystatin C,Cys-C)对高龄慢性肾脏病(chronic kidney disease,CKD)患者肾小球滤过率(glomerular filtration rate,GFR)的评估价值。方法选择年龄大于75岁高龄男性CKD患者39例,肾图检测患者肾小球滤过率(GFR),检测血清肌酐(SCr)、Cys-C浓度,根据SCr水平使用CG公式、中国改良简化MDRD公式计算估计的GFR(eGFR),同时使用Hoek、Le Bricon公式利用Cys-C浓度计算eGFR。各组数据进行统计学分析。结果39例患者依肾图结果分别为CKD3、4、5期,Cys-C浓度在高龄患者中不受年龄、体重、身高等影响(P>0.05),其平均值在CKD3、4、5期分别为1.50±0.42、1.95±0.65、2.98±0.73mg/L,与肾图相关性在CKD5期最高(r=-0.8976、P<0.05)。在CKD3、4期,SCr、CG及中国改良简化MDRD公式与肾图相关性稍高于Cys-C、Hoek及Le Bricon公式,在CKD5期则低于后者。结论Cys-C在高龄CKD患者不同期评估GFR的准确率存在一定的差异,在CKD5期与GFR相关性最高,优于SCr。Cys-C能否优于SCr更好地反映患者GFR有待于进一步的研究。

Objective To evaluate the potential role of Cystatin C for glomerular filtration rate（GFR）of senile patients with chronic kidney disease （CKD）. Methods Thirty-nine male CKD patients who were above 75 years old in our hospital were selected for detecting GFR by nephrogram,the concentrations of serum creatinine （SCr）and serum Cystatin C （Cys-C）were tested, eGFR was calculated by the equations of CG, simplified MDRD for Scr and Hoek,Le Bricon for Scys respectively. The results were analyzed statistically. Results All patients belonged to stage 3 to 5 according to the results of GFR by nephrogram. The concentration of serum Scys was not effected by age,weight, height （P〉0.05）, there was significant difference in the average concentration of serum Scys between stage 3,4,and 5 of CKD patients,and the highest correlation coefficient to GFR was in stage 5 CKD patients（P〈 0.05）. For Scys and the equations of Hoek and Le Bricon,their correlation coefficients to GFR were lower than those of Scr and the equations of CG,simptified MDRD in stage 3 or 4 CKD patients,but higher in stage 5（P〈0.05）. Conclusions The evaluation accuracy of GFR by Scys in different stages of senile CKD patients had no concordance,and the correlation coefficient to GFR was higher than that of Scr in stage 5 of senile CKD patients. Whether Scys is better at evaluating GFR of senile CKD patients than Scr needs more advanced research in future.