基于肌酐和胱抑素C的肾小球滤过率评估公式判断2型糖尿病肾病的预后

肾脏病与透析肾移植杂志 ›› 2016, Vol. 25 ›› Issue (2): 107-112.

基于肌酐和胱抑素C的肾小球滤过率评估公式判断2型糖尿病肾病的预后

出版日期:2016-04-28 发布日期:2016-05-04

Prediction of renal outcome by estimating GFR from a combination of serum creatinine and cystatin C in type 2 diabetic nephropathy

Online:2016-04-28 Published:2016-05-04

摘要/Abstract

摘要：

摘要
目的：比较三种肾小球滤过率（GFR）计算方法（eGFRcre，eGFRcys与eGFRcrecys），用于评价2型糖尿病肾病患者肾功能的准确性及在判断预后中的临床价值。方法：观察性研究共纳入2型糖尿病肾病随访登记数据库中501例患者，通过横断面分析，比较0、12、24月时用eGFRcre，eGFRcys与eGFRcrecys公式计算得到eGFR的分布及偏移状态，并随访观察12月和24月时不同eGFR下降幅度（20%，30%，40%，和57%）对判断患者肾脏终点事件的敏感性和特异性。结果：将eGFRcrecys设为参考，eGFRcre公式高估了GFR水平，在eGFRcrecys>120, 90-120, 60-90, 30-60,<30ml/min/1.73m2的2型糖尿病肾病患者中，中位偏移分别为-0.21，6.17，12.69，9.55，5.27 ml/min/1.73m2。低龄、高收缩压、低体质指数（BMI）和高血糖增加偏移度。基于eGFRcrecys公式24月的GFR下降速率较eGFRcre和eGFRcys公式更好的判断肾脏终点，曲线下面积（ROC）分别为0.857 ±0.0297，0.839±0.0319和0.796 ±0.0357。eGFRcrecys24月的GFR下降速率联合基线eGFRcrecys的GFR水平可以有效判断肾脏预后，ROC 达0.917± 0.0178。基线eGFR crecys>90ml/min/1.73m2的患者，以eGFRcrecys24月下降57%作为判断指标，敏感性和特异性均为100%；基线eGFRcrecys <90ml/(min.1.73m2)的患者，以 eGFRcrecys24月下降40%作为判断预后指标，其准确性更好。结论：在2型糖尿病肾病中，eGFRcre公式可能高估患者的GFR，尤其在eGFR60-120 ml/(min.1.73m2)的人群中。以eGFRcrecys公式计算的24月GFR下降57%和40%分别用于基线eGFRcrecys>90和<90ml/(min.1.73m2)的患者用于判断2型糖尿病肾病的肾脏预后的敏感性和特异性较好。

关键词: 胱抑素C, 肾小球滤过率, 2型糖尿病肾病, CKD-EPI公式, 肾脏预后

Abstract:

ABSTRACT Objective: To investigate estimated GFR from combination of serum creatinine and cystatin C as marker to predict long-term renal outcome in patient with Type 2 diabetic nephropathy (DN). Methodology: Five hundred one patients with DN were enrolled in this study. The levels of eGFRcre, eGFRcys, eGFRcrecys were assessed at baseline, 12, and 24 month. After the follow-up time of median 31 months, the end-stage renal disease (ESRD) risk related to percentage change in estimated GFR over one and 2 years were compared to the three equations. Result: compared with eGFRcrecys, eGFRcre overestimated GFR in DN. The absolute bias was -0.21，6.17，12.69，9.55，5.27 ml/min/1.73m2 when eGFRcrecys>120 ml/(min.1.73m2), 90~120 ml/(min.1.73m2), 60~90 ml/(min.1.73m2), 30~60 ml/(min.1.73m2),<30ml/(min.1.73m2), respectively. Lower age, higher systolic blood pressure, lower body mass index, and increased fast blood glucose contributed to the bias. eGFRcrecys slope over 2 year was superior to eGFRcre or eGFRcys to predict renal outcome, whose area under curve ( AUC ) was 0.857 ±0.0297 and the ROC of eGFRcrecys slope over 2 year combined with baseline eGFRcrecys was further increased to 0.917± 0.0178. Baseline eGFRcrecys >90ml/(min.1.73m2), 57% reduction over 2 years as an alternative end point, the sensitivity and specificity was 100%; Baseline eGFRcrecys <90 ml/(min.1.73m2), 40% reduction over 2 years could be an idea alternative end point. Conclusion: eGFRcre overestimated GFR in the patients with DN, in particular eGFR less than 120ml/(min.1.73m2), 57% reduction over 2 years in baseline eGFRcrecys > 90ml/(min.1.73m2) and 40% reduction over 2 years in baseline eGFRcrecys < 90ml/(min.1.73m2) could be an idea alternative end point to predict ESRD.

Key words: cystatin C, glomerular filtration rate, type 2 diabetic nephropathy, CKD-EPI, renal prognosis

潘瑜|蒋松|邱丹丹|等. 基于肌酐和胱抑素C的肾小球滤过率评估公式判断2型糖尿病肾病的预后[J]. 肾脏病与透析肾移植杂志, 2016, 25(2): 107-112.

PAN Yu|JIANG Song|QIU Dandan|et al. Prediction of renal outcome by estimating GFR from a combination of serum creatinine and cystatin C in type 2 diabetic nephropathy[J]. Chinese Journal of Nephrology, Dialysis & Transplantation, 2016, 25(2): 107-112.

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