Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement
Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement
复制标题
DOI：
10.1111/j.1523-1755.2004.00517.x
复制
发表时间：
2004-04-01
影响因子：
19.6
通讯作者：
De Jong, PE
中科院分区：
文献类型：
--
作者：
Knight, EL;Verhave, JC;De Jong, PE
背景众所周知，只有考虑到影响肌酐产生的因素，如年龄、性别和体重，血清肌酐才可用作肾功能的标志物。血清胱抑素C已被认为是比血清肌酐潜在上级的标志物，因为血清胱抑素C水平被认为是以恒定速率产生的，并且不受这些因素的影响。然而，有可能影响血清胱抑素C水平的因素，有有限的数据，并有有限的数据比较胱抑素C为基础的估计肾功能与肌酐为基础的估计，调整这些因素，特别是在个人正常，或轻度降低，肾功能。这是一项对荷兰格罗宁根市8058名28至75岁居民的横断面研究。测定血清胱抑素C和血清肌酐水平，并根据两次单独的24小时尿液采集的平均值确定肌酐清除率。我们进行了多变量分析，以确定因素独立相关的血清胱抑素C水平后，调整肌酐清除率。然后，在调整可能影响血清胱抑素C和肌酐水平的因素后，获得部分斯皮尔曼相关性。比较血清胱抑素C水平和血清肌酐水平对肌酐清除率的拟合优度（R2）。年龄较大、男性、体重较大、身高较大、吸烟和血清C反应蛋白（CRP）水平较高与肌酐清除率校正后血清胱抑素C水平较高独立相关。校正年龄、体重和性别后，肌酐与血清胱抑素C水平和血清肌酐水平的偏斯皮尔曼相关系数分别为0.29（P < 0.001）和-0.42（P < 0.001）。血清胱抑素C水平和血清肌酐水平经年龄、体重和性别校正后的R-2值分别为0.38和0.42。吸烟和血清CRP水平的增加并没有改善多变量血清胱抑素C为基础的模型的R-2值。血清半胱氨酸蛋白酶抑制剂C的影响因素以外的肾功能。此外，我们发现没有证据表明基于血清胱抑素C的多变量肾功能评估上级基于血清肌酐的多变量评估。
Background. It is well known that serum creatinine may be used as a marker of renal function only if taking into account factors that influence creatinine production, such as age, gender, and weight. Serum cystatin C has been proposed as a potentially superior marker than serum creatinine, because serum cystatin C level is believed to be produced at a constant rate and not to be affected by such factors. However, there are limited data on factors that may influence serum cystatin C levels, and there are limited data comparing cystatin C-based estimates of renal function with creatinine-based estimates that adjust for such factors, especially in individuals with normal, or mildly reduced, renal function.Methods. This was a cross-sectional study of 8058 inhabitants of the city of Groningen, The Netherlands, 28 to 75 years of age. Serum cystatin C and serum creatinine levels were measured, and creatinine clearance was determined from the average of two separate 24-hour urine collections. We performed multivariate analyses to identify factors independently associated with serum cystatin C levels after adjusting for creatinine clearance. Then, partial Spearman correlations were obtained after adjusting for factors that may influence serum cystatin C and creatinine levels. We also compared the goodness-of-fit (R 2)of different multivariate linear regression models including serum cystatin C level and serum creatinine level for the outcome of creatinine clearance.Results. Older age, male gender, greater weight, greater height, current cigarette smoking, and higher serum C-reactive protein (CRP) levels were independently associated with higher serum cystatin C levels after adjusting for creatinine clearance. After adjusting for age, weight, and gender, the partial Spearman correlations between creatinine and, respectively, serum cystatin C level and serum creatinine level were 0.29 (P < 0.001) and -0.42 (P < 0.001), respectively. The R-2 values for serum cystatin C level and serum creatinine level adjusted for age, weight, and gender were 0.38 and 0.42, respectively. The addition of cigarette smoking and serum CRP levels did not improve the R-2 value for the multivariate serum cystatin C-based model.Conclusion. Serum cystatin C appears to be influenced by factors other than renal function alone. In addition, we found no evidence that multivariate serum cystatin C-based estimates of renal function are superior to multivariate serum creatinine-based estimates.