[儿童肾小球滤过率的评估——血清标志物与预测方程]
[Evaluation of glomerular filtration rate in children--serum markers and prediction equations].
作者信息
Nakai Keiko, Kikuchi Masayuki, Koyamaa Tomiko, Saito Kensuke, Suwabe Akira
机构信息
Department of Laboratory Medicine, Iwate Medical University, Morioka, Japan.
出版信息
Rinsho Byori. 2009 Apr;57(4):338-44.
BACKGROUND
In children, determination of glomerular filtration rate(GFR) is not easy, because serum creatinine (CRE) level changes by their growth and collection of urine is difficult. In this study, we evaluated serum GFR markers and prediction equations of GFR.
METHODS
Serum samples were obtained from 200 healthy children; 100 children aged 9 to 10 years and 100 children aged 12 to 13 years (50 males and 50 females respectively). Serum levels of three GFR markers i.e., CRE, cystatin C, and beta2-microglobulin (beta2mG) were measured, and prediction equations of GFR were calculated. Another 110 serum samples were obtained from children aged 0 to 16 years, and the same three markers were measured.
RESULTS
In comparing healthy children aged 9 to 10 years and 12 to 13 years, serum CRE levels were significantly higher in the latter group. Serum cystatin C levels were not different between these two groups. Although serum levels of CRE, cystatin C, and beta2mG were not significantly different between males and females aged 9 to 10 years, significantly higher levels of these three markers were observed in males than females aged 12 to 13 years. The reference values of cystatin C and CRE were < or = 0.760 mg/l, < or = 0.623 mg/dl in children aged 9 to 10 years, and < or = 0.835 mg/l, < or = 0.785 mg/dl in children aged 12 to 13 years. Investigation of serum samples obtained from children aged 0 to 16 years suggested the better utility of cystatin C as a GFR marker compared to CRE. The Shwartz prediction equation is considered to be useful among the three CRE-based prediction equations, while the Rule prediction equation is considered to be useful among the three cystatin C-based prediction equations.
CONCLUSIONS
We need the reference value of serum CRE in each age and gender to evaluate GFR. And we concluded serum cystatin C is the better GFR marker than CRE in children. As to the prediction equations, the Shwartz and the Rule prediction equation are considered to be practically useful in children.
背景
在儿童中，肾小球滤过率（GFR）的测定并不容易，因为血清肌酐（CRE）水平会随其生长而变化，且尿液收集困难。在本研究中，我们评估了血清GFR标志物及GFR的预测方程。
方法
采集了200名健康儿童的血清样本，其中100名年龄在9至10岁，100名年龄在12至13岁（各50名男性和50名女性）。检测了三种GFR标志物即CRE、胱抑素C和β2-微球蛋白（β2mG）的血清水平，并计算了GFR的预测方程。另外从0至16岁儿童中采集了110份血清样本，并检测了相同的三种标志物。
结果
比较9至10岁和12至13岁的健康儿童，后一组的血清CRE水平显著更高。这两组之间的血清胱抑素C水平无差异。虽然9至10岁的男性和女性之间CRE、胱抑素C和β2mG的血清水平无显著差异，但在12至13岁的儿童中，男性的这三种标志物水平显著高于女性。9至10岁儿童胱抑素C和CRE的参考值分别为≤0.760mg/l、≤0.623mg/dl，12至13岁儿童分别为≤0.835mg/l、≤0.785mg/dl。对0至16岁儿童血清样本的研究表明，与CRE相比，胱抑素C作为GFR标志物的实用性更好。在基于CRE的三个预测方程中，施瓦茨预测方程被认为是有用的，而在基于胱抑素C的三个预测方程中，鲁尔预测方程被认为是有用的。
结论
我们需要各年龄和性别的血清CRE参考值来评估GFR。我们得出结论，在儿童中血清胱抑素C是比CRE更好的GFR标志物。至于预测方程，施瓦茨和鲁尔预测方程在儿童中被认为具有实际应用价值。
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