Factors other than glomerular filtration rate affect serum cystatin C levels.
Factors other than glomerular filtration rate affect serum cystatin C levels.
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DOI：
10.1038/ki.2008.638
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发表时间：
2009-03
影响因子：
19.6
通讯作者：
Levey AS
中科院分区：
文献类型：
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作者：
Stevens LA;Schmid CH;Greene T;Li L;Beck GJ;Joffe MM;Froissart M;Kusek JW;Zhang YL;Coresh J;Levey AS
半胱氨酸蛋白酶抑制剂C作为内源性滤过标志物的认可度越来越高。除肾小球滤过率（GFR）外，影响血清水平的其他因素尚未仔细研究。在对来自临床试验的参与者和慢性肾脏疾病临床人群（N=3418）的汇总数据集进行横断面分析时，我们使用变量误差模型将GFR校正后的血清胱抑素C和肌酐水平与临床和生化变量相关，以解释GFR测量误差。GFR测量为125 I-碘酞酸盐和15 Cr-EDTA的尿清除率。在单个实验室测定胱抑素C，并将肌酐标准化为参考方法。平均（SD）肌酐和胱抑素C分别为2.1（1.1）mg/dL和1.8（0.8）mg/L。校正GFR后，每20岁半胱氨酸蛋白酶抑制剂C降低4.3%，女性降低9.2%，但黑人仅降低1.9%。糖尿病与胱抑素C水平升高8.5%和肌酐水平降低3.9%相关。高C反应蛋白和白色血细胞计数以及低血清白蛋白与高胱抑素C水平和低肌酐水平相关。调整年龄、性别和种族对肌酐相关因素的影响大于半胱氨酸蛋白酶抑制剂C。总之，胱抑素C受GFR以外因素的影响。临床医生在解释血清水平或从胱抑素C估计GFR时应考虑这些因素。
Cystatin C is gaining acceptance as an endogenous filtration marker. Factors other than glomerular filtration rate (GFR) that affect the serum level have not been carefully studied. In a cross-sectional analysis of a pooled dataset of participants from clinical trials and a clinical population with chronic kidney disease (N=3418), we related serum levels of cystatin C and creatinine to clinical and biochemical variables after adjustment for GFR using errors-in-variables models to account for GFR measurement error. GFR was measured as urinary clearance of 125I-iothalamate and 15Cr-EDTA. Cystatin C was assayed at a single laboratory and creatinine was standardized to reference methods. Mean (SD) creatinine and cystatin C were 2.1 (1.1) mg/dL and 1.8 (0.8) mg/L, respectively. After adjustment for GFR, cystatin C was 4.3% lower for every 20 years of age, 9.2% lower for female sex but only 1.9% lower in blacks. Diabetes was associated with 8.5% higher levels of cystatin C and 3.9% lower levels of creatinine. Higher C-reactive protein and white blood cell count and lower serum albumin were associated with higher levels of cystatin C and lower levels of creatinine. Adjustment for age, sex and race had a greater effect on association of factors with creatinine than cystatin C. In conclusion, cystatin C is affected by factors other than GFR. Clinicians should consider these factors when interpreting the serum levels or GFR estimates from cystatin C.