Shlipak Michael G, Katz Ronit, Cushman Mary, Sarnak Mark J, Stehman-Breen Catherine, Psaty Bruce M, Siscovick David, Tracy Russell P, Newman Anne, Fried Linda
General Internal Medicine Section, San Francisco Veterans Affairs Medical Center and Department of Medicine, University of California, San Francisco, Calif 94121, USA.
Am J Med. 2005 Dec;118(12):1416. doi: 10.1016/j.amjmed.2005.07.060.
Inflammatory factors are elevated in persons with severe renal dysfunction, but their association across all levels of renal function is unclear. We compared cystatin-C, a novel marker of renal function, with creatinine and estimated glomerular filtration rate (eGFR) as predictors of C-reactive protein and fibrinogen levels.
This study is a cross-sectional analysis to evaluate cystatin-C, creatinine, and eGFR as predictors of the inflammatory markers C-reactive protein and fibrinogen. Participants included 4637 ambulatory elderly patients from the Cardiovascular Health Study. Multivariate linear regression was used to determine the independent associations of each renal function measurement with the inflammatory marker outcomes.
After adjustment for confounding factors, cystatin-C was correlated with both C-reactive protein (coefficient = 0.13; 95% confidence interval: 0.10-1.16, P <.0001) and fibrinogen levels (0.15; 0.13-0.18, P <.0001). Associations were larger than those for creatinine and C-reactive protein (0.05; 0.02-0.07, P = .003) or fibrinogen (0.07; 0.04-0.10, P <.0001). Adjusted levels of C-reactive protein increased incrementally across quintiles of cystatin-C, from a median of 2.2 mg/L in quintile 1 to 3.7 mg/L in quintile 5. In contrast, both C-reactive protein and fibrinogen had U-shaped associations with quintiles of creatinine and eGFR, because the inflammatory markers were equivalently elevated in quintiles 1 and 5.
The finding of a significant linear association of cystatin-C and inflammation markers suggests that even small reductions in renal function may be associated with adverse pathophysiologic consequences.
炎症因子在严重肾功能不全患者中升高，但其在所有肾功能水平中的关联尚不清楚。我们将新型肾功能标志物胱抑素-C与肌酐和估计肾小球滤过率（eGFR）进行比较，以预测C反应蛋白和纤维蛋白原水平。
本研究为横断面分析，评估胱抑素-C、肌酐和eGFR作为炎症标志物C反应蛋白和纤维蛋白原的预测指标。参与者包括来自心血管健康研究的4637名门诊老年患者。采用多元线性回归确定每种肾功能测量值与炎症标志物结果之间的独立关联。
在调整混杂因素后，胱抑素-C与C反应蛋白（系数=0.13；95%置信区间：0.10-1.16，P<.0001）和纤维蛋白原水平（0.15；0.13-0.18，P<.0001）均相关。其关联大于肌酐与C反应蛋白（0.05；0.02-0.07，P=.003）或纤维蛋白原（0.07；0.04-0.10，P<.0001）的关联。C反应蛋白的校正水平在胱抑素-C的五分位数中逐渐增加，从第1五分位数的中位数2.2mg/L增加到第5五分位数的3.7mg/L。相比之下，C反应蛋白和纤维蛋白原与肌酐和eGFR的五分位数呈U形关联，因为炎症标志物在第1和第5五分位数中同样升高。
胱抑素-C与炎症标志物之间存在显著线性关联的发现表明，即使肾功能有小幅度下降也可能与不良病理生理后果相关。
