血清胱抑素C和MDRD方程在慢性肾脏病诊断中的临床应用(1)
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【摘要】 目的 探讨血清胱抑素 C(Cys C)在诊断慢性肾脏病(CKD)的意义,以及Cys C与MDRD方程估计肾小球滤过率(GFR)的准确性及相关性。方法 根据MDRD方程7计算的肾小球滤过率(GFR)将CKD患者分为5期,ELISA法检测CKD患者的Cys C的水平,观察Cys C与血肌酐(Scr)、GFR的相关性。结果 Cys C与Scr呈正相关,与GFR呈负相关;在肾功能轻度损伤时,Cys C反映肾功能恶化程度的敏感度较Scr高。结论 ELISA法能够检测Cys C的水平,Cys C能够作为反映肾功能的可靠指标,并且是肾功能的早期诊断指标。CKD2 5期,Cys C与MDRD方程7有良好的相关性;Cys C与MDRD方程7能够作为CKD2 5期患者估计GFR的指标。
【关键词】慢性肾脏病;肾小球滤过率;胱抑素C;MDRD方程
Clinical diognostic value of serum Cystatin C and MDRD equation for chronic kidney disease
LIU Jun ping,ZHANG Li ping,LI Peng hua.Fenyang Hospital Shanxi Province,Fenyang 032200,China
【Abstract】 Objective To study the clinical value of Cys C and MDRD equation in the patient with CKD.GFR was estimated by Cys C and MDRD equation.To study the correlation between Cys C and MDRD equation.Methods According to the value of GFR of the patient with CKD,divided them into five groups.To study the correlation between Cys C and GFR.To explore the correlation between Cys C and Sc.Results Cys C was correlated with Scr.There was negative correlation between Cys C and GFR.When renal function slightly injured,Cys C was higher sensitivity than Scr.Conclusion It is reliable to detect Cys C by enzyme linked immunosorbent assay(ELISA).It is dependable to judge renal function by the level of Cys C.Cys C can be a sensitive marker to reflect GFR.GFR was estimated by Cys C and MDRD equation.It was correlation between Cys C and MDRD equation.
【Key words】Chronic kidney disease(CKD); Glomerular filtration rate(GFR); Cystatin C(Cys C); MDRD equation
临床工作中常用血清肌酐(Scr)、尿素氮(BUN)、血清肌酐清除率(Ccr)评价肾小球的滤过功能。Scr、BUN受很多肾内和肾外因素干扰,而Ccr是一种估计的肾小球滤过率(GFR),受肌肉容积和肾小管排泌等因素的影响,反应的GFR或低或高。因此,需要一种更能精确反应GFR的指标。血清胱抑素(Cys C)是半胱氨酸蛋白酶的抑制剂,分子量为13.3KDa,由机体所有有核细胞产生,Cys C经肾小球自由滤过,肾小管不分泌,在近曲小管被重新吸收并被降解,它的这些特性与内源性GFR指标的要求很相近,是近年来发现的一种很好地反映GFR的指标。本研究探讨Cys C在慢性肾脏病(CKD)肾功能损害中的临床价值,为临床提供一个简便、敏感地反映GFR的理想指标。
1 资料和方法
1.1 一般资料 我们抽取我科2008年3月至2009年5月确诊的肾内科CKD患者79名,男36例,女43例,年龄为19~82岁,根据美国NKF K/DOQI制订的指南[1]。把入选的CKD患者根据GFR水平分为5期:1期:GFR≥90 ml/(min•1 ......
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