在检测轻度而非重度糖尿病肾病方面，血清胱抑素C比血清肌酐更具优势。

Serum cystatin C advantageous compared with serum creatinine in the detection of mild but not severe diabetic nephropathy.

作者信息

Christensson A G, Grubb A O, Nilsson J-A, Norrgren K, Sterner G, Sundkvist G

机构信息

Department of Nephrology and Transplantation, Malmö University Hospital, SE-205 02 Malmö, Sweden.

出版信息

J Intern Med. 2004 Dec;256(6):510-8. doi: 10.1111/j.1365-2796.2004.01414.x.

DOI:10.1111/j.1365-2796.2004.01414.x

PMID:15554952

Abstract

OBJECTIVE

To determine whether serum cystatin C is more accurate than serum creatinine in the detection of diabetic nephropathy, also after adjustment for age.

METHODS

Forty-one patients with type 1 and 82 patients with type 2 diabetes were evaluated with serum creatinine, serum cystatin C, and (51)Cr-EDTA clearance (reference method). Cystatin C was measured by a particle-enhanced turbidimetric method and creatinine by an enzymatic method. Statistical estimations were performed both without and with age adjustment created by z-scores for (51)Cr-EDTA clearance, creatinine, and cystatin C. The cut-off levels for glomerular filtration rate (GFR) ((51)Cr-EDTA clearance) were 60 and 80 mL min(-1) 1.73 m(-2), respectively, in absolute values and 80, 90 and 95% CIs, respectively, in age-adjusted values (z-scores).

RESULTS

Estimations without age adjustment showed significantly (P = 0.0132) closer correlation for cystatin C (r = 0.817) versus (51)Cr-EDTA clearance as compared with creatinine (r = 0.678). However, when using age-adjusted values, the correlation for cystatin C and creatinine, respectively, versus (51)Cr-EDTA clearance did not differ. When comparing the diagnostic utilities for serum cystatin C versus serum creatinine in manifest renal impairment (GFR < 60 mL min(-1) 1.73 m(-2) or z-scores <-1.28 SD), there were no significant differences between the two markers whether age adjusted or not. However, for diagnosing mild nephropathy (GFR < 80 mL min(-1) 1.73 m(-2) or z-score -0.84 SD), serum cystatin C is significantly more useful.

CONCLUSIONS

Serum cystatin C performed better compared with serum creatinine even when measured enzymatically, to detect mild diabetic nephropathy. However, serum creatinine was as efficient as serum cystatin C to detect advanced diabetic nephropathy.

摘要

目的

确定血清胱抑素C在检测糖尿病肾病方面是否比血清肌酐更准确，年龄校正后亦是如此。

方法

对41例1型糖尿病患者和82例2型糖尿病患者进行血清肌酐、血清胱抑素C及（51）铬-乙二胺四乙酸清除率（参考方法）评估。胱抑素C采用颗粒增强比浊法测定，肌酐采用酶法测定。分别在未进行年龄校正以及通过（51）铬-乙二胺四乙酸清除率、肌酐和胱抑素C的z分数进行年龄校正的情况下进行统计估计。肾小球滤过率（GFR）（（51）铬-乙二胺四乙酸清除率）的截断水平，绝对值分别为60和80 mL·min⁻¹·1.73 m⁻²，年龄校正值（z分数）分别为80、90和95%置信区间。

结果

未进行年龄校正的估计显示，与肌酐（r = 0.678）相比，胱抑素C（r = 0.817）与（51）铬-乙二胺四乙酸清除率的相关性显著更高（P = 0.0132）。然而，使用年龄校正值时，胱抑素C和肌酐分别与（51）铬-乙二胺四乙酸清除率的相关性并无差异。比较血清胱抑素C和血清肌酐在显性肾功能损害（GFR < 60 mL·min⁻¹·1.73 m⁻²或z分数 < -1.28标准差）中的诊断效用时，无论是否进行年龄校正，两种标志物之间均无显著差异。然而，对于诊断轻度肾病（GFR < 80 mL·min⁻¹·1.73 m⁻²或z分数 < -0.84标准差），血清胱抑素C明显更有用。