Department of Nuclear Medicine, Aalborg Hospital, Aarhus University Hospital, Hobrovej 18-22, 9000 Aalborg, DK, Denmark.
Pediatr Nephrol. 2013 Jan;28(1):83-92. doi: 10.1007/s00467-012-2268-8. Epub 2012 Sep 4.
The aim of this study was to compare the ability of renal indicators [serum creatinine (SCr), cystatin C (SCysC)] and glomerular filtration rate (GFR)-models to discriminate normal and reduced renal function. As a single cut-off level will always lead to false classifications, we propose using two cut-off levels, dividing renal function into normal or reduced, with an intermediate "gray zone" of indeterminable results.
Glomerular filtration rate was measured by plasma clearance of (51)Cr-EDTA (13.7-147.4 mL/min/1.73 m(2)) in 119 children (age range 2.3-14.9 years). Reduced renal function was defined as a GFR of <82 mL/min/1.73 m(2). SCr, SCysC, age-normalized creatinine (SCr-ratio), and eight published GFR-models were compared for their ability to correctly classify renal function as normal or reduced. Cut-off levels were determined so as to give 99 % certainty outside the gray zone.
The multivariable GFR-models by Schwartz et al. (J Am Soc Nephrol 2009; 20:629-637) and Zappitelli et al. (Am J Kidney Dis 2006; 48:221-230) and two models by Andersen et al. [Am J Kidney Dis 2012; 59(1):50-57: body cell mass (BCM)-model and Weight-model] performed significantly better than all other variables (P < 0.01), with the BCM-model performing the best (P < 0.05). The SCr-based Schwartz formula and SCr-ratio both performed better than SCr and SCysC.
Among the 119 children enrolled in this study and the renal indicators tested, the BCM-model had the best diagnostic performance in terms of screening for normal or reduced renal function, and the SCr-ratio was a superior diagnostic tool to both SCr and SCysC.
本研究旨在比较肾脏指标（血清肌酐 [SCr]、胱抑素 C [SCysC]）和肾小球滤过率（GFR）模型区分正常和降低的肾功能的能力。由于单一截断值总会导致错误分类，因此我们建议使用两个截断值，将肾功能分为正常或降低，并将不确定结果的中间“灰色区域”分开。
通过 119 名儿童（年龄范围 2.3-14.9 岁）的血浆（51）Cr-EDTA 清除率（13.7-147.4 mL/min/1.73 m2）测量肾小球滤过率。定义肾功能降低为 GFR <82 mL/min/1.73 m2。比较了 SCr、SCysC、年龄归一化肌酐（SCr-ratio）和 8 种已发表的 GFR 模型，以确定它们正确分类肾功能正常或降低的能力。确定截断值以使 99%的可能性不在灰色区域之外。
Schwartz 等人的多变量 GFR 模型（J Am Soc Nephrol 2009; 20:629-637）和 Zappitelli 等人的模型（Am J Kidney Dis 2006; 48:221-230）以及 Andersen 等人的两个模型[Am J Kidney Dis 2012; 59(1):50-57：身体细胞质量（BCM）-模型和 Weight 模型]均显著优于其他所有变量（P < 0.01），其中 BCM 模型表现最佳（P < 0.05）。基于 SCr 的 Schwartz 公式和 SCr-ratio 均优于 SCr 和 SCysC。
在本研究纳入的 119 名儿童和测试的肾脏指标中，BCM 模型在筛查正常或降低的肾功能方面具有最佳的诊断性能，而 SCr-ratio 是比 SCr 和 SCysC 更好的诊断工具。
