Bargnoux Anne-Sophie, Barguil Yann, Cavalier Etienne, Cristol Jean-Paul
Laboratoire de biochimie, PhyMedExp, Université de Montpellier, Inserm, CNRS, CHU de Montpellier, France.
Laboratoire de biochimie-toxicologie, Centre hospitalier territorial Gaston-Bourret, Nouméa, Nouvelle-Calédonie.
Ann Biol Clin (Paris). 2019 Aug 1;77(4):375-380. doi: 10.1684/abc.2019.1456.
Blood concentration of cystatin C is independent of muscle mass and tubular secretion. It can be used, in the absence of a reference method, as an alternative marker to creatinine for the evaluation of renal function and the estimation of glomerular filtration rate (GFR). Both particle-enhanced immunonephelemetry (PENIA) or immunoturbidimetry (PETIA) methods are available to determine cystatin C. From an analytical point of view, it is recommended to use methods whose calibration is traceable to the reference material (ERM-DA471/IFCC) and to report an estimated GFR based on cystatin C. The main equations used are those developed in 2012 by the group "Chronic kidney disease epidemiology collaboration (CKD-EPI)" for adults and those published by Schwartz in 2012 for children. National and international recommendations suggest using a cystatin C-based GFR estimate as a confirmatory test in the clinical settings where the relationship between creatinine production and muscular mass impairs the clinical performance of creatinine. The indications retained by the working group were graded according to the level of recommendations. The essential indications are the estimation and/or the monitoring of renal function in children and adolescents due to rapid changes in muscle mass; in patients with impaired muscle mass and in patients with an alteration of tubular secretion of creatinine (essentially iatrogenic effects).
胱抑素C的血药浓度与肌肉量和肾小管分泌无关。在缺乏参考方法的情况下，它可作为肌酐的替代标志物，用于评估肾功能和估计肾小球滤过率（GFR）。颗粒增强免疫比浊法（PENIA）或免疫透射比浊法（PETIA）均可用于测定胱抑素C。从分析角度来看，建议使用校准可溯源至参考物质（ERM-DA471/IFCC）的方法，并报告基于胱抑素C的估计GFR。主要使用的公式是2012年由“慢性肾脏病流行病学协作组（CKD-EPI）”为成年人制定的公式，以及2012年由施瓦茨为儿童发表的公式。国家和国际建议表明，在肌酐生成与肌肉量之间的关系损害肌酐临床性能的临床环境中，使用基于胱抑素C的GFR估计值作为确证试验。工作组保留的适应症根据推荐级别进行分级。基本适应症包括因肌肉量快速变化而对儿童和青少年肾功能进行估计和/或监测；用于肌肉量受损的患者以及肌酐肾小管分泌改变（主要是医源性影响）的患者。
