Gowans E M, Fraser C G
Department of Biochemical Medicine, Ninewells Hospital and Medical School, Dundee, Scotland.
Ann Clin Biochem. 1988 May;25 ( Pt 3):259-63. doi: 10.1177/000456328802500312.
Analytical and intra- and inter-individual components of variation were assessed over a 40-week period in 15 apparently healthy subjects, seven men and eight women, for serum creatinine, urine creatinine expressed in both concentration and output terms, and creatinine clearance, both uncorrected and corrected to standard surface area of 1.73 m2. Serum creatinine, even when considered separately for men and women, has marked individuality, and conventional population-based reference ranges are consequently of limited value. In contrast, urinary creatinine and creatinine clearance have less individuality, and reference ranges are more useful. Desirable analytical standards are not attained for serum creatinine assays, but are achieved for urine creatinine and clearance determinations. Creatinine clearance is, therefore, the favoured first-line test for initial assessment of patients. However, the small critical difference required for two serum creatinine results to be significantly different, and the comparatively large critical difference for clearance, make serial serum creatinine assays more useful for monitoring individuals.
在15名表面健康的受试者（7名男性和8名女性）中，对血清肌酐、以浓度和排出量表示的尿肌酐以及未校正和校正至1.73 m²标准体表面积的肌酐清除率，在40周的时间内评估了变异的分析性、个体内和个体间成分。血清肌酐，即使分别考虑男性和女性，也具有显著的个体差异，因此基于人群的传统参考范围价值有限。相比之下，尿肌酐和肌酐清除率的个体差异较小，参考范围更有用。血清肌酐检测未达到理想的分析标准，但尿肌酐和清除率测定达到了。因此，肌酐清除率是对患者进行初始评估的首选一线检测方法。然而，两个血清肌酐结果要有显著差异所需的临界差异小，而清除率的临界差异相对较大，使得连续血清肌酐检测对个体监测更有用。
