Detection of renal function decline in patients with diabetes and normal or elevated GFR by serial measurements of serum cystatin C concentration: Results of a 4-year follow-up study
Detection of renal function decline in patients with diabetes and normal or elevated GFR by serial measurements of serum cystatin C concentration: Results of a 4-year follow-up study
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DOI：
10.1681/asn.2004100854
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发表时间：
2005-05-01
影响因子：
13.6
通讯作者：
Warram, JH
中科院分区：
文献类型：
--
作者：
Perkins, BA;Nelson, RG;Warram, JH
糖尿病早期肾功能下降的研究受到缺乏简单工具的阻碍，这些工具可用于检测GFR正常或升高时肾功能随时间推移的趋势（特别是系统性下降）。本研究旨在评估血清胱抑素C满足这一需求的程度。糖尿病肾病研究中的30名2型糖尿病患者符合这三个合格标准：基线时GFR > 20 ml/min/1.73 m2（基于冷碘酞酸盐清除率），4年随访，碘酞酸盐清除率和血清胱抑素C的年度测量。使用线性回归，确定每个个体的肾功能随时间的趋势，表示为碘酞酸清除率的年度百分比变化。将血清胱抑素C（mg/L）转换为其倒数（100/胱抑素C），并使用线性回归确定每个个体随时间的趋势，表示为年度百分比变化。在每次检查时100/半胱氨酸蛋白酶抑制剂C与碘酞酸清除率的配对比较中，两种测量值在数值上相似。更重要的是，100/半胱氨酸蛋白酶抑制剂C和碘酞酸盐清除率的趋势强相关（斯皮尔曼r = 0.77）。所有20例碘酞酸盐清除率呈阴性趋势（肾功能下降）的受试者的100/半胱氨酸蛋白酶抑制剂C也呈阴性趋势。只有三名参与者的结果不一致。相比之下，三种常用的基于肌酐的GFR估计值的趋势与碘酞酸盐清除率的趋势相比较差（斯皮尔曼r < 0.35）。血清胱抑素C的系列测量可准确检测GFR正常或升高患者的肾功能趋势，并为研究糖尿病早期肾功能下降提供了手段。
Research on early renal function decline in diabetes is hampered by lack of simple tools for detecting trends (particularly systematic decreases) in renal function over time when GFR is normal or elevated. This study sought to assess how well serum cystatin C meets that need. Thirty participants with type 2 diabetes in the Diabetic Renal Disease Study met these three eligibility criteria: GFR > 20 ml/min per 1.73 m 2 at baseline (based on cold iothalamate clearance), 4 yr of follow-up, and yearly measurements of iothalamate clearance and serum cystatin C. With the use of linear regression, each individual's trend in renal function over time, expressed as annual percentage change in iothalamate clearance, was determined. Serum cystatin C in mg/L was transformed to its reciprocal (100/cystatin C), and linear regression was used to determine each individual's trend over time, expressed as annual percentage change. In paired comparisons of 100/cystatin C with iothalamate clearance at each examination, the two measures were numerically similar. More important, the trends in 100/cystatin C and iothalamate clearance were strongly correlated (Spearman r = 0.77). All 20 participants with negative trends in iothalamate clearance (declining renal function) also had negative trends for 100/cystatin C. Results were discordant for only three participants. In contrast, the trends for three commonly used creatinine-based estimates of GFR compared poorly with trends in iothalamate clearance (Spearman r < 0.35). Serial measures of serum cystatin C accurately detect trends in renal function in patients with normal or elevated GFR and provide means for studying early renal function decline in diabetes.