血清肌酐、尿素、尿酸和胱抑素C在肾功能损伤的诊断价值

Diagnostic value of serum creatinine,urea,uric acid and cystatin C in renal injury

目的评价血清肌酐、尿素、尿酸和胱抑素C在肾功能损伤中的诊断价值。方法依据肾脏发射型计算机断层影像检查结果,284例患者分为GFR≥90ml/min(肾功能正常组,59例)、GFR 60~89ml/min(轻度损伤组,136例)和GFR<60ml/min(中重度损伤组,89例)三组。采用ROC曲线分析血清肌酐、尿素、尿酸和胱抑素C水平诊断肾功能损伤的灵敏度、特异度和准确度。结果尿素对肾功能轻度损伤和中重度损伤诊断的特异度分别为98.33%和87.56%。血清胱抑素C对肾功能轻度损伤和中重度损伤诊断的灵敏度分别为84.18%和96.25%。结论血清胱抑素C是预测肾小球滤过率下降的最敏感指标,可作为肾功能损伤诊断的主要依据;而尿素和尿酸诊断的特异度相对较高,联合使用时可提高诊断的准确度。

Objective To evaluate the diagnostic value of serum creatinine,urea,uric acid and cystatin C in the assessment of renal injury.Methods According to the glomerular filtration rate（GFR）determined by renal emission computed tomography,284 patients were divided into three groups of A（GFR≥90 ml/min,59 cases）,B（GFR 60-89 ml/min,136 cases）and C（GFR60 ml/min,89 cases）.The sensitivity and specificity of serum creatinine,urea,uric acid and cystatin C in the diagnosis of renal injury were analuzed using ROC curve.Results In the diagnosis of mild renal injury and moderate to serious renal injury,the specificities of serum urea level were 98.33% and 87.56%and the sensitivities of cystatin were 84.18% and 96.25%.Conclusion Serum level of cystatin C is the most sensitive indicator for predicting the decrease of GFR and may be considered as the main basis in the early diagnosis of renal injury.The specificity of urea and uric acid is relatively higher for diagnosing renal injury,combination of which can increase the accuracy of diagnosis.