Perlemoine Caroline, Beauvieux Marie-Christine, Rigalleau Vincent, Baillet Laurence, Barthes Nicole, Derache Philippe, Gin Henri
Service de Diabétologie-NUtrition, USN, Hôspital cardiologique du Haut-Lévêque, Pessac, France.
Metabolism. 2003 Oct;52(10):1258-64. doi: 10.1016/s0026-0495(03)00193-8.
We compared cystatin C, creatinine, and the Cockroft formula for assessment of early renal failure, defined as a (51)Cr-EDTA clearance < 80 mL/min, in 89 diabetic patients with various degrees of renal impairment (glomerular filtration rate [GFR], 11.4 to 196.5 mL/min). The relationships between cystatin C, creatinine, and (51)Cr-EDTA clearance were linearized by plotting the reciprocals of the values, and correlation coefficients were determined. Sensitivity and specificity for the diagnosis of early renal failure were calculated from receiver operating characteristic (ROC) curves. Over the whole population, cystatin C was as well correlated with GFR (r =.74) as was creatinine (r =.67) or the Cockroft formula (r =.88). Moreover, its diagnostic accuracy was comparable to that of the 2 other parameters. Its sensitivity (86.8%) was better than that of creatinine (77.4%) for screening GFR < 80 mL/min, although the Cockroft formula was more sensitive (96.2%). The study of albuminuric diabetics (n = 63) led to similar conclusions, except for a poor sensitivity of cystatin C. In the 36 patients whose plasma creatinine was < 1 mg/dL, 10 (27.7%) had GFR < 80 mL/min. The correlation of creatinine with GFR, its diagnostic accuracy, and sensitivity were significantly lower than those of cystatin C. In this population of patients with normal creatinine levels, the correlation coefficient of cystatin C, its sensitivity, and its diagnostic accuracy were comparable to those of the Cockroft formula. A moderate reduction in GFR may be present in diabetic patients with low creatinine levels. Although Cockroft formula remains the most reliable and the less expensive tool for the evaluation of renal function, cystatin C is a more reliable criterion for screening and assessment than creatinine and represents a useful alternative to the Cockcroft-Gault formula.
我们比较了胱抑素C、肌酐和Cockcroft公式在评估89例不同程度肾功能损害（肾小球滤过率[GFR]为11.4至196.5 mL/min）的糖尿病患者早期肾衰竭（定义为(51)Cr-EDTA清除率<80 mL/min）中的作用。通过绘制各值的倒数使胱抑素C、肌酐与(51)Cr-EDTA清除率之间的关系线性化，并确定相关系数。根据受试者工作特征（ROC）曲线计算诊断早期肾衰竭的敏感性和特异性。在整个人群中，胱抑素C与GFR的相关性（r = 0.74）与肌酐（r = 0.67）或Cockcroft公式（r = 0.88）相当。此外，其诊断准确性与其他两个参数相当。在筛查GFR<80 mL/min时，其敏感性（86.8%）优于肌酐（77.4%），尽管Cockcroft公式更敏感（96.2%）。对蛋白尿糖尿病患者（n = 63）的研究得出了类似结论，只是胱抑素C的敏感性较差。在36例血浆肌酐<1 mg/dL的患者中，10例（27.7%）的GFR<80 mL/min。肌酐与GFR的相关性、诊断准确性和敏感性均显著低于胱抑素C。在这群肌酐水平正常的患者中？胱抑素C的相关系数、敏感性和诊断准确性与Cockcroft公式相当。肌酐水平低的糖尿病患者可能存在GFR中度降低。虽然Cockcroft公式仍然是评估肾功能最可靠且成本较低的工具，但胱抑素C在筛查和评估方面比肌酐更可靠，是Cockcroft-Gault公式的有用替代方法。 ？处原文可能有误，推测为“在这群肌酐水平正常的患者中”
