Bökenkamp A, Domanetzki M, Zinck R, Schumann G, Byrd D, Brodehl J
Children's Hospital of Hannover Medical School, Hannover Medical School, Hannover, Germany.
Pediatrics. 1998 May;101(5):875-81. doi: 10.1542/peds.101.5.875.
Serum creatinine is the most common endogenous marker of renal function. The proportionality between creatinine production and muscle mass requires adjustment for height and body composition. The low molecular weight protein cystatin C is produced by all nucleated cells and eliminated by glomerular filtration. Therefore, cystatin C was studied as an alternative marker of glomerular filtration rate (GFR) in children.
Cystatin C and creatinine were measured in sera from inulin clearance (CIn) examinations performed in 184 children aged 0.24 to 17.96 years. CIn ranged from 7 to 209 mL/min/1.73 m (median, 77).
The reciprocal of cystatin C correlated better with CIn (r = 0.88) than the reciprocal of creatinine (r = 0.72). Stepwise regression analysis identified no covariates for the correlation between cystatin C and CIn, whereas height was a covariate for creatinine. Using an estimate of GFR from serum creatinine and height, correlation with CIn was similar to cystatin C, but female gender and dystrophy were associated with an overestimation of GFR. Diagnostic accuracy in the identification of reduced GFR measured as area under the receiver-operating characteristic plot was 0.970 +/- 0.135 (mean +/- SE) for cystatin C and 0.894 +/- 0.131 for creatinine (NS). A cutoff cystatin C concentration of 1.39 mg/L had 90% sensitivity and 86% specificity for detecting abnormal GFR.
Unlike creatinine, serum cystatin C reflects renal function in children independent of age, gender, height, and body composition.
血清肌酐是最常用的肾功能内源性标志物。肌酐生成与肌肉量之间的比例关系需要根据身高和身体组成进行调整。低分子量蛋白质胱抑素C由所有有核细胞产生，并通过肾小球滤过清除。因此，胱抑素C被作为儿童肾小球滤过率（GFR）的替代标志物进行研究。
对184名年龄在0.24至17.96岁儿童进行菊粉清除率（CIn）检查，测定血清中的胱抑素C和肌酐。CIn范围为7至209 mL/min/1.73 m（中位数为77）。
胱抑素C的倒数与CIn的相关性（r = 0.88）优于肌酐的倒数（r = 0.72）。逐步回归分析确定，胱抑素C与CIn之间的相关性不存在协变量，而身高是肌酐的协变量。根据血清肌酐和身高估算GFR，其与CIn的相关性与胱抑素C相似，但女性和营养不良与GFR高估有关。以受试者工作特征曲线下面积衡量，胱抑素C识别降低GFR的诊断准确性为0.970±0.135（均值±标准误），肌酐为0.894±0.131（无显著性差异）。胱抑素C浓度截断值为1.39 mg/L时，检测异常GFR的灵敏度为90%，特异度为86%。
与肌酐不同，血清胱抑素C反映儿童肾功能时不受年龄、性别、身高和身体组成的影响。
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