【作者】 季丰科；

【导师】 熊佩华；

【作者基本信息】 苏州大学 ， 中西医结合临床， 2009， 硕士

【摘要】 目的探讨血清半胱氨酸蛋白酶抑制剂C (Cystatin C )、血清肌酐(Scr)及尿微量蛋白(α1-MG、ALB、TRF)在评价慢性肾脏病患者肾功能损害中的比较及血清CysC浓度判定在肾小球滤过功能中的临床价值。方法收集自2008年1月至2008年11月本院住院的慢性肾脏病患者62例,采用酶联免疫吸附实验(ELISA)检测每例患者的血清半胱氨酸蛋白酶抑制剂C的浓度,同时记录每例患者的血清肌酐及尿微量蛋白(α1-MG、ALB、TRF)的浓度。依据Cockcroft-Gault方程及本院实验室所测内生肌酐清除率(Ccr)两者的均值为实际Ccr。以MDRD方程计算出的近似肾小球滤过率(eGFR)为评价标准,来比较Cystatin C,、Scr、Ccr、尿α1-MG、ALB、TRF与eGFR的相关性。采用受试者工作特征曲线下面积(AUCROC)和灵敏度来评价Cystatin C的可靠性。结果患者血清Cystatin C, Scr, Ccr与eGFR均呈显著相关,相关系数分别为-0.940,-0.931,0.935(P均<0.01)。尿α1-MG、ALB、TRF与eGFR的相关程度较低,相关系数分别为-0.554,-0.484,-0.237。各指标以Cystatin C与eGFR的相关程度最密切。CysC、Scr、α1-MG、ALB、TRF的AUCROC分别为0.985,0.924,0.732,0.682,0.564,以CysC的AUCROC最大,且Cystatin C与Scr的AUCROC之间比较具有统计学意义(P<0.05),Cystatin C与α1-MG的AUCROC之间比较具有统计学意义(P<0.01),灵敏度也以血清Cystatin C较Scr、α1-MG、ALB、TRF为佳(灵敏度分别为96.8%、91.9%、87.1%,80.6%,79.0%)。结论与血清Scr、尿α1-MG、ALB、TRF相比,血清Cystatin C是一个更为准确、灵敏的反映肾小球滤过功能的指标,对较早期反映各种慢性肾脏病患者肾小球滤过功能的损害具有重要价值。更多还原

【Abstract】 Objective: To evaluate the applicability of serum cystatin C ,serum creatinine and urine microprotein as endogenous marker for detection of renal disfunction in patients with chronic kidney disease. Methods:Serum samples were obtained from 62 cases who were got with chronic kidney disease, collected from January in 2008 to November in 2008 among our own hospitalized patient. Serum cystatin C concentration was determined by enzyme-linked immunosorbent assay(ELISA),and we record every illness’s Serum creatinine(Scr) and urine microprotein (α1-MG、ALB,TRF),and we measured Creatinine clearance rate(Ccr) accord to Cockcroft-Gault equations and our native hospital analysis ,and then we mean the two numerical value as the last numerical values. At the same time, we evaluate the estimated glomerular filtration rate( eGFR) accord to equations MDRD,then we serve eGFR as evaluation criterion,to compare the relation among CysC,Scr,Ccr,α1-MG,ALB,TRF and eGFR. The correlation between eGFR and above parameters were compared,and the areas which under the Receiver Operating Chacteristic curve(AUCROC), and the sensitivity ,they were all used for revaluating the reliability of cystatinC。Results: We found significant correlation between eGFR and cystatin C, Scr, Ccr,r is -0.940,-0.931,-0.935 respectively (p<0.01)。α1-MG,ALB and TRF have a low relationship between eGFR, r is -0.554,-0.484,-0.237 respectively。So the relationship between eGFR and cystatin C was the most strongest。The AUCROC for cystatinC ,Scr ,α1-MG,ALB,TRF are 0 .985, 0.924,0.732,0.682,0.564 respectively, there was significant statistical difference between cystatin C and Scr (P<0.05),and there was also significant statistical difference between cystatin C andα1-MG (P<0.01)。To refer to sensitivity ,the serum cystatin C was the best among the above five parameters,the sensitivity are 96.8%, 91.9%,87.1%,80.6%,79.0%respectively。Conclusion: serum cystatin C determination is an accurate and ready-witted parameter of GFR。It can be a better endogenous marker for detection of early renal disfunction in patients who were with chronic kidney disease than serum creatinine ,urineα1-MG,ALB and TRF。更多还原