比较胱抑素C与采用血清肌酐估测肾小球滤过率在高血压病、糖尿病患者肾功能分期中的价值

Comparison of Cystatin C and Formula eGFR Based on Serum Creatinine to Evaluate Renal Function in Patients with Hypertension,Diabetes

目的评价血清胱抑素C(CysC)公式、MDRD简化公式及Cockcroft-Gault公式在高血压病、糖尿病患者中进行肾功能不全分期中的价值。方法收集具有99 mTc-DTPA肾动态显像、CysC、血肌酐(SCr)等完整数据资料住院患者276例。根据99 mTc-DTPA肾动态显像检测结果将患者分为5个等级,采用CysC公式、MDRD简化公式及Cockcroft-Gault公式分别计算推测GFR(GFR胱抑素C、GFRMDRD及GFRG-C)。结果 99 mTc-DTPA肾动态显像诊断225个患者合并肾功能损害,CysC公式:灵敏度88.44%,特异性80.39%,MDRD简化公式:灵敏度90.67%,特异性72.55%,Cockcroft-Gault公式:灵敏度92.89%,特异性66.67%。Pearson相关分析显示:各计算公式计算的GFR与99 mTc-DTPA肾动态显像、CysC、血清肌酐及GFR胱抑素C、GFRMDRD、GFRG-C显著相关(P<0.01)。一致性检验:Kappa系数分别为GFR胱抑素C0.35、GFRMDRD0.33、GFRG-C0.389(P<0.01)。GFR胱抑素C、GFRMDRD及GFRG-C三者总体正确分级率无显著性差异(P=0.41),仅在第4期CysC分级准确率优于其他2种公式计算的GFR(P=0.003)。3种计算公式曲线下面积无显著性差异(P>0.05)。结论采用血清CysC公式、MDRD简化公式、Cockcroft-Gault公式计算的GFR是评价高血压病、糖尿病患者肾功能损害的敏感和可靠的指标,三种公式具有相似的分级准确率。

Objective To evaluate the using of serum cystatin C（CysC）,the simplified MDRD and Cockcroft-Gault formulas in the classification of the renal function in hypertension,diabetic patients.Method 276 hospitalized patients with complete profiles of 99mTc-DTPA renal dynamic imaging,CysC,serum creatinine（SCr） were enrolled.According to the result of 99mTc-DTPA renal dynamic imaging,276 patients were divided into five grades.Glomerular filtration rates（GFR） was estimated by using CysC,simplified MDRD and Cockcroft-Gault formulas separately.Results The results of 99mTc-DTPA renal dynamic imaging showed 225 patients with renal dysfunction.The sensitivity of cystatin C was 88.44% and specificity was 80.39%;simplified MDRD formula＇s sensitivity was 90.67%,and specificity was 72.55%;the Cockcroft-Gault formula＇s sensitivity was 92.89%,and specificity was 66.67%.Pearson correlation analysis showed that： Glomerular filtration rates calculated by formulas were significantly correlated with 99mTc-DTPA renal dynamic imaging,Cys C,surum creatinine,GFRCysC,GFRMDRD,GFRG-C（all P0.05）.Consistency test： Kappa coefficients were GFRCysC 0.35,GFRMDRD0.33,GFRG-C 0.389（all P0.05）.Cystatin C,simplified MDRD and Cockcroft-Gault formulas had the similar overall correct classification rates（P=0.41）,except in the fourth grade level,cystatin C was superior to the other two（P=0.003）.There are no significant differences among areas under ROC curve in three calculate formulas.Conclusion GFR estimated by serum CysC,simplified MDRD or Cockcroft-Gault formulas are sensitive and reliable indicators to evaluate the renal dysfunction in patients with hypertension,diabetes.The three formulas have similar accuracy in renal function classification.