Maillard Nicolas, Mariat Christophe, Bonneau Christine, Mehdi Manolie, Thibaudin Lise, Laporte Silvy, Alamartine Eric, Chamson Annette, Berthoux François
Service de Néphrologie, Dialyse, Transplantation Rénale, Laboratoires d'Explorations Fonctionnelles Rénales, Saint-Etienne, France.
Transplantation. 2008 Jun 27;85(12):1855-8. doi: 10.1097/TP.0b013e3181744225.
Creatinine-based glomerular filtration rate (GFR) estimators perform poorly in renal transplant recipients. Cystatin C might be a better alternative to serum creatinine in assessing renal graft function. We compared several cystatin C-based equations with the modification diet renal disease (MDRD) equation in 120 adult renal transplant recipients for whom the GFR was measured by the gold standard inulin clearance. Mean inulin-measured GFR was 52.6 mL/min/1.73 m (range, 13-119). The Hoek, Rule, Le Bricon, and Filler cystatin C-based formulas showed significantly better performances (accuracy 30% of 82%, 81%, 78%, and 71%), than the MDRD equation (58%, Mac Nemar test, P<0.01). Sensitivity to detect a GFR below 60 mL/min/1.73 m was significantly higher for the Hoek and the Rule equations (0.95, 95% CI 0.91-1) than for the MDRD equation (0.76, 95% CI 0.67-0.85). These data confirm that cystatin C as a GFR marker offers significant advantages over creatinine in renal transplantation.
基于肌酐的肾小球滤过率（GFR）估算公式在肾移植受者中表现不佳。在评估肾移植功能时，胱抑素C可能是血清肌酐的更好替代指标。我们在120例成年肾移植受者中，将几个基于胱抑素C的公式与改良肾脏病饮食（MDRD）公式进行了比较，这些受者的GFR通过金标准菊粉清除率测量。菊粉测量的平均GFR为52.6 mL/min/1.73 m²（范围为13 - 119）。基于胱抑素C的Hoek、Rule、Le Bricon和Filler公式的表现显著优于MDRD公式（准确率分别为82%、81%、78%和71%，而MDRD公式为58%，麦克内马尔检验，P<0.01）。Hoek和Rule公式检测GFR低于60 mL/min/1.73 m²的敏感性显著高于MDRD公式（分别为0.95，95%可信区间0.91 - 1）（MDRD公式为0.76，95%可信区间0.67 - 0.85）。这些数据证实，在肾移植中，胱抑素C作为GFR标志物比肌酐具有显著优势。
