肾移植中基于胱抑素C的公式：能否更精准地预测肾小球滤过率？
Cystatin C-based equations in renal transplantation: moving toward a better glomerular filtration rate prediction?
作者信息
Maillard Nicolas, Mariat Christophe, Bonneau Christine, Mehdi Manolie, Thibaudin Lise, Laporte Silvy, Alamartine Eric, Chamson Annette, Berthoux François
机构信息
Service de Néphrologie, Dialyse, Transplantation Rénale, Laboratoires d'Explorations Fonctionnelles Rénales, Saint-Etienne, France.
出版信息
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。
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