比较血清胱抑素 C、血清肌酐、肾小球滤过率实测值和估计值，以评估有糖尿病肾病的美国印第安人发生肾衰竭的风险。
Comparison of serum cystatin C, serum creatinine, measured GFR, and estimated GFR to assess the risk of kidney failure in American Indians with diabetic nephropathy.
机构信息
Centers for Disease Control and Prevention, Atlanta, GA, USA.
出版信息
Am J Kidney Dis. 2013 Jul;62(1):33-41. doi: 10.1053/j.ajkd.2012.11.044. Epub 2013 Jan 21.
BACKGROUND
We compared values of baseline serum cystatin C (SCysC), serum creatinine (SCr), and measured glomerular filtration rate (mGFR) for predicting end-stage renal disease (ESRD) in patients with type 2 diabetes and elevated albuminuria.
STUDY DESIGN
Observational longitudinal study.
SETTING & PARTICIPANTS: Pima Indians with type 2 diabetes and elevated albumin-creatinine ratio (ACR ≥30 mg/g).
PREDICTORS
Baseline SCysC, SCr, and mGFR.
OUTCOMES & MEASUREMENTS: Individuals were followed up from their first examination with diabetes and ACR ≥30 mg/g until December 2010, onset of ESRD, or death, whichever came first. Incidence rates adjusted for age and sex were computed by Mantel-Haenszel stratification. The abilities of SCysC, SCr, and mGFR values to predict ESRD were compared with receiver operating characteristic curves.
RESULTS
Of 234 Pima Indians with a mean age of 42.8 years who were followed up for a median of 10.7 (range, 0.6-21.3) years, 68 (29%) developed ESRD. The incidence of ESRD was significantly higher in patients in the lowest versus highest tertile of 1/SCysC (incidence rate ratio, 2.43; 95% CI, 1.31-4.50). By contrast, mGFR and 1/SCr had J-shaped associations with ESRD. In unadjusted analyses, 1/SCysC had the highest area under the receiver operating characteristic curve (AUROC; 0.719 ± 0.035) and mGFR had the lowest (0.585 ± 0.042; P < 0.001); the AUROC for 1/SCr was intermediate (0.672 ± 0.040; P = 0.1 and P = 0.03 vs 1/SCysC and mGFR, respectively). In analyses adjusted for age, sex, diabetes duration, height, weight, hemoglobin A1c level, and ACR, 1/SCysC had the highest AUROC (0.845 ± 0.026). Models with mGFR or 1/SCr alone had similar AUROCs (P = 0.9) and both were lower than the model with 1/SCysC alone (P = 0.02 and P = 0.03, respectively).
LIMITATIONS
The predictive values of the filtration markers are limited to the extent that their precision is based on a single measurement.
CONCLUSIONS
SCysC level was a better predictor of ESRD than mGFR or SCr level in Pima Indians with type 2 diabetes and elevated albuminuria.
背景
我们比较了基线血清胱抑素 C（SCysC）、血清肌酐（SCr）和估算肾小球滤过率（mGFR）在预测 2 型糖尿病伴白蛋白尿升高患者终末期肾病（ESRD）中的价值。
研究设计
观察性纵向研究。
地点和参与者
2 型糖尿病伴白蛋白-肌酐比（ACR≥30mg/g）升高的皮马印第安人。
预测因子
基线 SCysC、SCr 和 mGFR。
结局和测量
个体从首次糖尿病和 ACR≥30mg/g 检查开始随访，直至 2010 年 12 月 ESRD 发作或死亡，以先发生者为准。通过 Mantel-Haenszel 分层计算年龄和性别调整后的发生率。通过受试者工作特征曲线比较 SCysC、SCr 和 mGFR 值预测 ESRD 的能力。
结果
在 234 名平均年龄为 42.8 岁的皮马印第安人中，中位随访时间为 10.7 年（范围，0.6-21.3 年），68 名（29%）发生 ESRD。最低与最高三分之一 1/SCysC 相比，ESRD 的发生率明显更高（发病率比，2.43；95%CI，1.31-4.50）。相比之下，mGFR 和 1/SCr 与 ESRD 呈 J 形关联。在未调整分析中，1/SCysC 的受试者工作特征曲线下面积（AUROC）最高（0.719±0.035），mGFR 最低（0.585±0.042；P<0.001）；1/SCr 的 AUROC 居中（0.672±0.040；P=0.1 和 P=0.03，分别与 1/SCysC 和 mGFR 相比）。在调整年龄、性别、糖尿病病程、身高、体重、糖化血红蛋白水平和 ACR 后，1/SCysC 的 AUROC 最高（0.845±0.026）。仅使用 mGFR 或 1/SCr 的模型具有相似的 AUROCs（P=0.9），均低于仅使用 1/SCysC 的模型（P=0.02 和 P=0.03，分别）。
局限性
滤过标志物的预测值仅限于其精度基于单次测量的程度。
结论
在 2 型糖尿病伴白蛋白尿升高的皮马印第安人中，SCysC 水平是预测 ESRD 的更好指标，优于 mGFR 或 SCr 水平。
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