尿胱抑素C：斯里兰卡慢性肾脏病负担高的地区儿童的儿科参考区间及作为肾损伤生物标志物的比较评估

Urinary cystatin C: pediatric reference intervals and comparative assessment as a biomarker of renal injury among children in the regions with high burden of CKDu in Sri Lanka.

作者信息

Sandamini Patabandi Maddumage Mihiri Ayesha, De Silva Pallage Mangala Chathura Surendra, Gunasekara Thibbotuwa Deniya Kankanamge Sameera Chathuranga, Gunarathna Sakuntha Dewaka, Pinipa Ranawake Arachchige Isini, Herath Chula, Jayasinghe Sudheera Sammanthi, Chandana Ediriweera Patabandi Saman, Jayasundara Nishad

机构信息

Department of Zoology, Faculty of Science, University of Ruhuna, Matara, 81000, Sri Lanka.

Department of Nephrology, Sri Jayewardenepura General Hospital, Colombo, 10100, Sri Lanka.

出版信息

World J Pediatr. 2022 Mar;18(3):196-205. doi: 10.1007/s12519-022-00513-9. Epub 2022 Feb 2.

DOI:10.1007/s12519-022-00513-9

PMID:35107783

Abstract

BACKGROUND

Cystatin C (Cys-C) is an emerging biomarker of renal diseases and its clinical use, particularly for screening the communities affected by chronic kidney disease of unknown etiology (CKDu), is hindered due to the lack of reference intervals (RIs) for diverse ethnic and age groups. The present study aimed to define RIs for urinary Cys-C (uCys-C) for a healthy pediatric population in Sri Lanka and in turn compare the renal function of the residential children in CKDu endemic and non-endemic regions in Sri Lanka.

METHODS

A cross-sectional study was conducted with 850 healthy children (10-17 years) from selected locations for reference interval establishment, while a total of 892 children were recruited for the comparative study. Urine samples were collected and analyzed for Cys-C, creatinine (Cr) and albumin. Cr-adjusted uCys-C levels were partitioned by age, and RIs were determined with quantile regression (2.5th, 50th and 97.5th quantiles) at 90% confidence interval.

RESULTS

The range of median RIs for uCys-C in healthy children was 45.94-64.44 ng/mg Cr for boys and 53.58-69.97 ng/mg Cr for girls. The median (interquartile range) uCys-C levels of children in the CKDu endemic and non-endemic regions were 58.18 (21.8-141.9) and 58.31 (23.9-155.3) ng/mg Cr with no significant difference (P = 0.781). A significant variation of uCys-C was noted in the children across age.

CONCLUSIONS

Notably high uCys-C levels were observed in children with elevated proteinuria. Thus, uCys-C could be a potential biomarker in identifying communities at high risk of CKDu susceptibility.

摘要

背景

胱抑素C（Cys-C）是一种新兴的肾脏疾病生物标志物，由于缺乏不同种族和年龄组的参考区间（RIs），其临床应用，特别是用于筛查受病因不明的慢性肾脏病（CKDu）影响的社区受到阻碍。本研究旨在确定斯里兰卡健康儿童人群尿胱抑素C（uCys-C）的参考区间，进而比较斯里兰卡CKDu流行地区和非流行地区居住儿童的肾功能。

方法

进行了一项横断面研究，从选定地点招募850名健康儿童（10 - 17岁）以建立参考区间，同时共招募892名儿童进行比较研究。收集尿液样本并分析其中的胱抑素C、肌酐（Cr）和白蛋白。根据年龄对经肌酐校正的uCys-C水平进行划分，并采用分位数回归（第2.5、50和97.5分位数）在90%置信区间确定参考区间。

结果

健康儿童uCys-C的中位数参考区间范围为男孩45.94 - 64.44 ng/mg Cr，女孩53.58 - 69.97 ng/mg Cr。CKDu流行地区和非流行地区儿童的uCys-C中位数（四分位间距）分别为58.18（21.8 - 141.9）和58.31（23.9 - 155.3）ng/mg Cr，无显著差异（P = 0.781）。不同年龄儿童的uCys-C存在显著差异。