The accuracy of cystatin C and commonly used creatinine-based methods for detecting moderate and mild chronic kidney disease in diabetes
The accuracy of cystatin C and commonly used creatinine-based methods for detecting moderate and mild chronic kidney disease in diabetes
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DOI：
10.1111/j.1464-5491.2007.02112.x
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发表时间：
2007-04-01
影响因子：
3.5
通讯作者：
Jerums, G.
中科院分区：
文献类型：
--
作者：
MacIsaac, R. J.;Tsalamandris, C.;Jerums, G.
背景：血清半胱氨酸氨基转移酶C检测糖尿病慢性肾脏病(CKD)不同阶段的准确性尚不清楚。方法在251例受试者的横断面研究中，用~(99)TC-DTPA血浆清除率(IGFR)测定参考肾小球滤过率(GFR)。多变量分析被用来确定与血清胱抑素C和IGFR水平独立的临床和生化关联。结果在整个研究人群中，相同的5个变量，即年龄、尿白蛋白排泄率、血红蛋白、大血管病史和甘油三酯水平与Cstatin C和IGFR水平独立相关。与肌酸法相比，血清胱抑素C水平界值82.1nmol/L(1.10 mg/L)是检测中度慢性肾脏病(每1.73m(2)的60ml/min)的最佳筛查工具。在轻度CKD的上限(每1.73m(2)90ml/min)，胱抑素C的诊断准确率也高于肌酐，但与以肌酐为基础的预测肾功能的公式相比具有相似的诊断准确性。结论本研究表明，与血清胱抑素C水平相关的临床和生化指标与与GFR相关的指标密切相关，并强调了通过简单测量血清胱抑素C水平在糖尿病患者中筛查中度或轻度CKD的潜在用处。
Background The accuracy of measuring serum cystatin C levels for detecting various stages of chronic kidney disease (CKD) in diabetes is still unclear.Methods In a cross-sectional study of 251 subjects, a reference glomerular filtration rate (GFR) was measured using Tc-99c-DTPA plasma clearance (iGFR). Multivariate analysis was used to identify independent clinical and biochemical associations with serum cystatin C and iGFR levels. The diagnostic accuracy of cystatin C and commonly used creatinine-based methods of measuring renal function (serum creatinine, the MDRD four-variable and Cockcroft-Gault formulae) for detecting mild and moderate CKD was also compared.Results In the entire study population the same five variables, age, urinary albumin excretion rates, haemoglobin, history of macrovascular disease and triglyceride levels were independently associated with both cystatin C and iGFR levels. A serum cystatin C level cut-off > 82.1 nmol/l (1.10 mg/l) had the best test characteristics as a screening tool for detecting moderate CKD (< 60 ml/min per 1.73 m(2)) when compared with creatinine-based methods. At the upper threshold for mild CKD (< 90 ml/min per 1.73 m(2)), cystatin C also had greater diagnostic accuracy than creatinine, but had similar diagnostic accuracy when compared with creatinine-based formulae for predicting renal function.Conclusions This study suggests that the clinical and biochemical parameters associated with serum cystatin C levels are closely linked to those associated with GFR and highlights the potential usefulness of screening for moderate or mild CKD in subjects with diabetes by simply measuring serum cystatin C levels.