Ma Y-C, Zuo L, Chen J-H, Luo Q, Yu X-Q, Li Y, Xu J-S, Huang S-M, Wang L-N, Huang W, Wang M, Xu G-B, Wang H-Y
Division of Nephrology and Institute of Nephrology, The First Hospital, Peking University, Xicheng District, Beijing, China.
Kidney Int. 2007 Dec;72(12):1535-42. doi: 10.1038/sj.ki.5002566. Epub 2007 Sep 26.
Plasma creatinine may not reflect glomerular filtration rate (GFR) especially in the early stages of chronic kidney disease (CKD). Plasma cystatin C (cysC), however, has the potential to more accurately determine early GFR reduction. We sought to improve the creatinine-based GFR estimation by including cysC measurements. We derived a reference GFR from standard dual plasma sampling (99m)Tc-DTPA clearance in a training cohort of 376 randomly selected adult Chinese patients with CKD. We compared reference values to estimated GFR and applied multiple regression models to one equation based solely on cysC, and to another combining plasma creatinine (Pcr) and cysC measurements of the training cohort. The results were validated by testing an additional 191 patients. The difference, precision, and accuracy of the two estimates were compared with the modified Modification of Diet in Renal Disease (MDRD) equation for Chinese patients, and another estimate combining cysC and modified MDRD calculations. The estimated GFR combining Pcr and cysC measurements more accurately matched the reference GFR at all stages of CKD than the other equations, particularly in patients with near-normal kidney function.
血肌酐可能无法反映肾小球滤过率（GFR），尤其是在慢性肾脏病（CKD）的早期阶段。然而，血浆胱抑素C（cysC）有可能更准确地确定早期GFR降低情况。我们试图通过纳入cysC测量来改进基于肌酐的GFR估算。我们在一个由376名随机选择的成年中国CKD患者组成的训练队列中，通过标准双血浆采样（99m）Tc-DTPA清除率得出参考GFR。我们将参考值与估算的GFR进行比较，并将多元回归模型应用于一个仅基于cysC的方程，以及另一个结合训练队列血浆肌酐（Pcr）和cysC测量值的方程。通过对另外191名患者进行测试来验证结果。将这两种估算方法的差异、精密度和准确性与针对中国患者的改良版肾脏病饮食改良（MDRD）方程，以及另一种结合cysC和改良MDRD计算的估算方法进行比较。与其他方程相比，结合Pcr和cysC测量值的估算GFR在CKD的所有阶段都更准确地匹配参考GFR，尤其是在肾功能接近正常的患者中。
