在预测肝硬化患者的肾小球滤过率方面，血清胱抑素-C并不优于血清肌酐。

Serum cystatin-C is not superior to serum creatinine in predicting glomerular filtration rate in cirrhotic patients.

作者信息

Nasseri-Moghaddam Siavosh, Ganji Mohamad-Reza, Kochari Mohammad-Reza, Tofangchiha Shahnaz

机构信息

Associated professor' Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences Tehran, Iran.

Associated professor, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Middle East J Dig Dis. 2013 Oct;5(4):209-16.

PMID:24829693

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3990151/

Abstract

BACKGROUND

Assessment of glomerular filtration rate (GFR) by common creatininebasedmethods is potentially inaccurate in patients with cirrhosis. Cirrhoticpatients have several underlying conditions that contribute to falsely low serumcreatinine concentrations, even in the presence of moderate to severe renalimpairment. Therefore creatinine-based methods usually overestimate trueGFR in these patients. Cystatin-C is a low molecular weight protein and anendogenous marker of GFR. We compared the accuracy of plasma cystatin-Cand creatinine in assessing renal function in cirrhotic patients.

METHODS

We serially enrolled cirrhotic patients with stable renal function admitted inour ward if they met the inclusion criteria and consented to participate. Child-Pugh (CP) score was calculated for all patients. GFR was calculated usingserum creatinine, serum cystatin-C, and 99m TC-DTPA clearance with the lastone serving as the gold standard. The area under curve (AUC) on receiveroperatingcharacteristic curves (ROC) were used to assess the diagnostic accuracyof each calculated GFR with that measured by DTPA.

RESULTS

Fourty-eight patients were enrolled (32 males, 66.7%). Nine were in class-A,20 in class-B and 19 in class-C of CP. Cystatin-C did not perform well in predictingthe true GFR, while serum creatinine performed relatively accurately atGFR<80ml/min (AUC=0.764, p=0.004). Serum creatinine at a cutoff of 1.4 mg/dl was 20% sensitive & 92% specific and with at a cutoff of 0.9 mg/dl was 77%sensitive & 72% specific for diagnosis of impaired renal function. Cystatin-Ccould not predict GFR effectively even after stratification for CP score, gender,and BMI. Serum creatinine could predict GFR<65ml/min in females (ROCcurve AUC=0.844, p=0.045). In those with BMI>20 kg/m2 a GFR<80 ml/mincould also be predicted by serum creatinine (ROC curve AUC=0.739, p=0.034).It also could predict GFR<80ml/min in patients with CP class A & B (ROC curveAUC=0.795, p=0.01), but not in patients with CP class C.

CONCLUSION

Neither serum creatinine nor Cystatin-C are good predictors of GFR in cirrhoticpatients, although serum creatinine seems to perform better in selectedsubgroups.

摘要

背景

在肝硬化患者中，采用基于肌酐的常用方法评估肾小球滤过率（GFR）可能不准确。肝硬化患者存在多种基础疾病，即使存在中度至重度肾功能损害，这些疾病也会导致血清肌酐浓度假性降低。因此，基于肌酐的方法通常会高估这些患者的真实GFR。胱抑素-C是一种低分子量蛋白质，是GFR的内源性标志物。我们比较了血浆胱抑素-C和肌酐在评估肝硬化患者肾功能方面的准确性。

方法

我们连续纳入了符合纳入标准并同意参与的本病房收治的肾功能稳定的肝硬化患者。计算所有患者的Child-Pugh（CP）评分。使用血清肌酐、血清胱抑素-C和99m锝-二乙三胺五醋酸（99m TC-DTPA）清除率计算GFR，以最后一项作为金标准。采用受试者操作特征曲线（ROC）上的曲线下面积（AUC）来评估每种计算得到的GFR与DTPA测量值的诊断准确性。

结果

共纳入48例患者（男性32例，占66.7%）。CP分级中，A级9例，B级20例，C级19例。胱抑素-C在预测真实GFR方面表现不佳，而血清肌酐在GFR<80ml/min时表现相对准确（AUC=0.764，p=0.004）。血清肌酐截断值为1.4mg/dl时，对肾功能损害诊断的敏感性为20%，特异性为92%；截断值为0.9mg/dl时，敏感性为77%，特异性为72%。即使按CP评分、性别和体重指数分层后，胱抑素-C也无法有效预测GFR。血清肌酐可预测女性GFR<65ml/min（ROC曲线AUC=0.844，p=0.045）。在体重指数>20kg/m2的患者中，血清肌酐也可预测GFR<80ml/min（ROC曲线AUC=0.739，p=0.034）。在CP A级和B级患者中，血清肌酐也可预测GFR<80ml/min（ROC曲线AUC=0.795，p=0.01），但在CP C级患者中则不能。