Madero Magdalena, Sarnak Mark J
Division of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, México City, Mexico.
Curr Opin Nephrol Hypertens. 2009 May;18(3):258-63. doi: 10.1097/mnh.0b013e328326f3dd.
To discuss recent studies which have evaluated determinants of cystatin C and to focus on the relationship of cystatin C with mortality, cardiovascular disease (CVD), and noncardiovascular outcomes.
In the Chronic Kidney Disease Epidemiology Study cystatin C was associated with demographic characteristics independent of measured glomerular filtration rate (GFR), although this was to a smaller extent than creatinine. In patients with established chronic kidney disease (CKD), cystatin C was strongly and inversely correlated with measured GFR, suggesting that although cystatin C may have other determinants, it is primarily a measure of kidney function. Several cohort studies, particularly in older adults, have now demonstrated that cystatin C is linearly associated with mortality, CVD and non-CVD outcomes, whereas creatinine is primarily associated with risk in individuals with more advanced kidney disease. A recent study has also shown that changes in kidney function as ascertained by cystatin C, even within the relatively normal range, are associated with subsequent CVD and all-cause mortality among older adults.
Cystatin C appears to capture an association of mild kidney disease with increased risk of mortality, CVD and non-CVD outcomes. Future studies should evaluate whether cystatin C can improve medical decision-making and lead to favorable patient outcomes.
讨论近期评估胱抑素C决定因素的研究，并重点关注胱抑素C与死亡率、心血管疾病（CVD）及非心血管疾病结局之间的关系。
在慢性肾脏病流行病学研究中，胱抑素C与人口统计学特征相关，且独立于测得的肾小球滤过率（GFR），尽管其程度小于肌酐。在已确诊的慢性肾脏病（CKD）患者中，胱抑素C与测得的GFR呈强负相关，这表明尽管胱抑素C可能有其他决定因素，但它主要是肾功能的一项指标。几项队列研究，尤其是在老年人中进行的研究，现已证明胱抑素C与死亡率、CVD及非CVD结局呈线性相关，而肌酐主要与更晚期肾病患者的风险相关。最近一项研究还表明，由胱抑素C确定的肾功能变化，即使在相对正常范围内，也与老年人随后发生的CVD及全因死亡率相关。
胱抑素C似乎揭示了轻度肾病与死亡率、CVD及非CVD结局风险增加之间的关联。未来的研究应评估胱抑素C是否能改善医疗决策并带来良好的患者结局。
