血清胱抑素C在狼疮性肾病中评估肾小球滤过率的研究

Study of serum cystatin C at assessment the glomerular filtration rate in patients with lupus nephropathy

目的 比较不同肾小球滤过率系统性红斑狼疮（SLE）患者血清胱抑素C（CysC）水平,探讨CysC与肾小球滤过率的相关性.方法 选择柳州医学高等专科学校第一附属医院2008年1月～2013年1月收治的SLE患者128例,按内生肌酐清除率（Ccr）值分为3组：Ccr≥90 mL/（min·1.73 m2）为CKD1组（41例）;60≤Ccr＜ 90mL/（min· 1.73m2）为CKD2组（43例）;Ccr＜60 mL/（min· 1.73 m2）为CKD3组（44例）.对照组30例为健康体检者.测定各组CysC水平、血肌酐（Scr）,计算Ccr、肾小球率过滤（CG-GFR）.采用ROC曲线比较诊断价值.结果 ①CKD2组、CKD3组患者CysC水平均明显高于CKD1组及对照组;CKD3组CysC水平高于CKD2组,差异均有高度统计学意义（P＜0.01）,显示随Ccr下降,CysC水平逐渐升高.②以Ccr 90 mL/（min· 1.73 m2）和60 mL/（min·1.73 m2）为切点作CysC、CG-GFR、Scr的ROC曲线,曲线下面积差异有高度统计学意义（P＜0.01）;以Ccr 30 mL/（min·1.73 m2）为切点作CysC、CG-GFR、Scr的ROC曲线,曲线下面积差异无统计学意义（P＞0.05）.结论 Ccr在90 mL/（min·1.73 m2）和60 mL/（min·1.73 m2）时,CysC对Ccr的诊断效能最强.CysC水平的升高与狼疮性肾病密切有关,能敏感地评估狼疮性肾病早中期肾功能损害.

Objective To compare the serum cystatin C （CysC） level in different stage of glomerular filtration rate in patients with systemic lupus erythematosus,and to investigate the correlation between CysC and glomerular filtration rate.Methods 128 patients with systemic lupus erythematosus in the First Affiliated Hospital of Liuzhou Medical College from January 2008 to January 2013 were selected and divided into 3 groups according to creatinine clearance rate （Ccr） values：41 cases with Ccr≥90 mL/（min·1.73 m2） were chosen as CKD1 group,43 cases with 60≤Ccr＜ 90 mL/（min·1.73 m2） were selected as CKD2 group,44 cases with Ccr＜60 mL/（min· 1.73 m2） were chosen as CKD3 group.30 healthy people were selected as control group.The CysC level,serum creatinine （Scr） and creatinine clearance rate （Ccr）,CG-GFR were measured in each group.ROC curve was used to compare the diagnostic value.Results ①The CysC levels in CKD2 group,CKD3 group were higher than those in CKD1 group and control group; CysC levels in CKD3 group was high than that in CKD2 group,the differences were statistically significant （P ＜ 0.01）,CysC levels were gradually increased along with the decrease of Ccr.②ROC curves of CysC,CG-GFR,Scr were made by the cut point of Ccr 90 mL/（min · 1.73 m2） and 60 mL/（min· 1.73 m2）,the differences of area under curve were statistically significant （P ＜ 0.01）; ROC curves of CysC,CG-GFR,Scr were made by the cut point of Ccr 30 mL/（min· 1.73 m2）,the differences of area under curve was not statistically significant （P ＞ 0.05）.Conclusion The diagnostic efficiency of CysC to Ccr is the highest at the Ccr 90 mL/（min· 1.73 m2） and 60 mL/（min· 1.73 m2）.The rise of CysC levels has relation with lupus nephropathy,it can evaluate the early renal damage with medium-term lupus nephropathy sensitively.