Cystatin C, a novel indicator of renal function, reflects severity of cerebral microbleeds.
Cystatin C, a novel indicator of renal function, reflects severity of cerebral microbleeds.
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DOI：
10.1186/1471-2377-14-127
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发表时间：
2014-06-12
期刊：
影响因子：
2.6
通讯作者：
Yoon BW
中科院分区：
文献类型：
--
作者：
Oh MY;Lee H;Kim JS;Ryu WS;Lee SH;Ko SB;Kim C;Kim CH;Yoon BW
慢性肾功能不全，诊断基于肌酐估计肾小球滤过率（GFR）或微量白蛋白尿，与脑微出血（CMBs）的存在有关。胱抑素C已被证明是一个比传统肾脏标志物更敏感的肾脏指标。在脑和肾存在相似的小血管病理机制的假设下，我们假设胱抑素C水平可以通过检测亚临床肾功能不全来描绘CMBs与肾功能不全的关系，从而更准确地反映CMBs的严重程度，而其他指标可能低估了亚临床肾功能不全。前瞻性地收集了683例缺血性脑卒中患者的数据。CMBs的严重程度根据病变数量进行分类。根据胱抑素C、估计GFR和微量白蛋白/肌酐比值将患者分为四分位数。采用有序logistic回归分析来检验各肾脏指标与CMBs的关系。在包括胱抑素C和估计GFR的四分位数的模型中，与估计GFR相比，只有胱抑素C四分位数具有显著性（最高对最低，调整OR， 1.88; 95% CI 1.05-3.38; p = 0.03）（最高对最低，调整OR， 1.28; 95% CI 0.38-4.36; p = 0.70）。包括半胱抑素C和微量白蛋白/肌酐比值的模型也显示，只有半胱抑素C四分位数与CMBs相关（调整后OR为最高vs.最低，2.06;95% CI 1.07-3.94; p = 0.03）。这些关联也在使用log转化胱氨酸抑制素C、白蛋白/肌酐比率和估计GFR作为连续变量的logistic模型中观察到。胱抑素C是深部或幕下CMBs的重要指标，但不是严格意义上的大叶CMBs。此外，胱抑素C在C -统计学中对CMBs的存在表现出最大的显著性（AUC = 0.73±0.03;95% CI 0.66-0.76; p = 0.02）。在肾脏疾病标志物中，胱抑素C可能是CMB严重程度最敏感的指标。
Chronic renal insufficiency, diagnosed using creatinine based estimated glomerular filtration rate (GFR) or microalbumiuria, has been associated with the presence of cerebral microbleeds (CMBs). Cystatin C has been shown to be a more sensitive renal indicator than conventional renal markers. Under the assumption that similar pathologic mechanisms of the small vessel exist in the brain and kidney, we hypothesized that the levels of cystatin C may delineate the relationship between CMBs and renal insufficiency by detecting subclinical kidney dysfunction, which may be underestimated by other indicators, and thus reflect the severity of CMBs more accurately. Data was prospectively collected for 683 patients with ischemic stroke. The severity of CMBs was categorized by the number of lesions. Patients were divided into quartiles of cystatin C, estimated GFR and microalbumin/creatinine ratios. Ordinal logistic regression analysis was used to examine the association of each renal indicator with CMBs. In models including both quartiles of cystatin C and estimated GFR, only cystatin C quartiles were significant (the highest vs. the lowest, adjusted OR, 1.88; 95% CI 1.05-3.38; p = 0.03) in contrast to estimated GFR (the highest vs. the lowest, adjusted OR, 1.28; 95% CI 0.38-4.36; p = 0.70). A model including both quartiles of cystatin C and microalbumin/creatinine ratio also showed that only cystatin C quartiles was associated with CMBs (the highest vs. the lowest, adjusted OR, 2.06; 95% CI 1.07-3.94; p = 0.03). These associations were also observed in the logistic models using log transformed-cystatin C, albumin/creatinine ratio and estimated GFR as continuous variables. Cystatin C was a significant indicator of deep or infratenorial CMBs, but not strictly lobar CMBs. In addition, cystatin C showed the greatest significance in c-statistics for the presence of CMBs (AUC = 0.73 ± 0.03; 95% CI 0.66-0.76; p = 0.02). Cystatin C may be the most sensitive indicator of CMB severity among the renal disease markers.
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DOI：
10.1056/nejmoa1114248
发表时间：
2012-07-05
期刊：
The New England journal of medicine
影响因子：
--
作者：
Inker LA;Schmid CH;Tighiouart H;Eckfeldt JH;Feldman HI;Greene T;Kusek JW;Manzi J;Van Lente F;Zhang YL;Coresh J;Levey AS;CKD-EPI Investigators
通讯作者：
CKD-EPI Investigators
影响因子：
8.3
作者：
Ikram, M. Arfan;Vernooij, Meike W.;Breteler, Monique M. B.
通讯作者：
Breteler, Monique M. B.
影响因子：
19.6
作者：
Levey, AS;Eckardt, KU;Eknoyan, G
通讯作者：
Eknoyan, G
影响因子：
48
作者：
Greenberg, Steven M.;Vernooij, Meike W.;Cordonnier, Charlotte;Viswanathan, Anand;Salman, Rustorn Al-Shahi;Warach, Steven;Launer, Lenore J.;Van Buchem, Mark A.;Breteler, Monique M. B.
通讯作者：
Breteler, Monique M. B.
影响因子：
--
作者：
Appel, Lawrence J.;Wright, Jackson T., Jr.;Agodoa, Lawrence Y.
通讯作者：
Agodoa, Lawrence Y.