Cystatin C versus Creatinine in Determining Risk Based on Kidney Function
发布于：2013-09-10
文章来源：
BACKGROUND
Adding the measurement of cystatin C to that of serum creatinine to determine the estimated glomerular filtration rate (eGFR) improves accuracy, but the effect on detection, staging, and risk classification of chronic kidney disease across diverse populations has not been determined.
背景：联合血肌酐和胱抑素C可更准确地评估推算肾小球滤过率（eGFR），但这种方案能否准确地对慢性肾病进行监测、分期和风险分层等仍然未知。
METHODS
We performed a meta-analysis of 11 general-population studies (with 90,750 participants) and 5 studies of cohorts with chronic kidney disease (2960 participants) for whom standardized measurements of serum creatinine and cystatin C were available. We compared the association of the eGFR, as calculated by the measurement of creatinine or cystatin C alone or in combination with creatinine, with the rates of death (13,202 deaths in 15 cohorts), death from cardiovascular causes (3471 in 12 cohorts), and end-stage renal disease (1654 cases in 7 cohorts) and assessed improvement in reclassification with the use of cystatin C.
方法：我们对11项基于人群的研究（共计90,750名参与者），以及5项慢性肾病人群队列研究进行了meta分析。他们均已接受血肌酐和胱抑素C的测定。我们比较了以下几种情况的差异：单独进行胱抑素C测定、单独进行血肌酐测定、联合测定，对死亡、心血管源性死亡、终末期肾病发生率等指标分别进行了评估，希望筛选出最准确的检测组合。同时了解胱抑素C再次风险分层是否有改善。
RESULTS
In the general-population cohorts, the prevalence of an eGFR of less than 60 ml per minute per 1.73 m2 of body-surface area was higher with the cystatin C–based eGFR than with the creatinine-based eGFR (13.7% vs. 9.7%). Across all eGFR cateries, the reclassification of the eGFR to a higher value with the measurement of cystatin C, as compared with creatinine, was associated with a reduced risk of all three study outcomes, and reclassification to a lower eGFR was associated with an increased risk. The net reclassification improvement with the measurement of cystatin C, as compared with creatinine, was 0.23 (95% confidence interval [CI], 0.18 to 0.28) for death and 0.10 (95% CI, 0.00 to 0.21) for end-stage renal disease. Results were generally similar for the five cohorts with chronic kidney disease and when both creatinine and cystatin C were used to calculate the eGFR.
结果：在一般人群队列中，利用胱抑素C推算的eGFR低于60 ml/min/1.73 m2的人群比例高于肌酐（13.7% vs. 9.7%）。在所有eGFR的分类方法中，胱抑素C的预测价值要高于血肌酐，并与三个研究终点风险下降有关。如果胱抑素C重新评估风险后，eGFR不升反降，那么风险会更高。胱抑素C与血肌酐比较后的净重新分类改善率为：死亡风险0.23，终末期肾病分先0.10。而五个慢性肾病队列中，两种测定方法的结果类似。
CONCLUSIONS
The use of cystatin C alone or in combination with creatinine strengthens the association between the eGFR and the risks of death and end-stage renal disease across diverse populations.
结论：在不同的人群中，单独使用胱抑素C或联合测定血肌酐，可更有效地评估eGFR，并更准确地评估死亡、终末期肾病等风险。
胱抑素C的简介：1983年Anastasi等首次在鸡蛋清中分离纯化得到高纯度的半胱氨酸蛋白酶抑制剂（cysteine proteinase inhibitor，CPI）后被命名为胱抑素C.是一种半胱氨酸蛋白酶抑制剂,也被称为γ-微量蛋白及γ-后球蛋白，广泛存在于各种组织的有核细胞和体液中,是一种低分子量、碱性非糖化蛋白质，分子量为13.3KD,由122个氨基酸残基组成,可由机体所有有核细胞产生，产生率恒定。循环中的胱抑素 c仅经肾小球滤过而被清除，是一种反映肾小球滤过率变化的内源性标志物,并在近曲小管重吸收，但重吸收后被完全代谢分解，不返回血液，因此，其血中浓度由肾小球滤过决定，而不依赖任何外来因素，如性别、年龄、饮食的影响，是一种反映肾小球滤过率变化的理想同源性标志物。
摘自《新英格兰医学杂志》2013年9月5日刊
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