血清胱抑素C公式和肌酐公式对评估中国人肾小球滤过率精准度的比较

    The serum cystain C-based equation is more accurateto estimate the glomerular filtrations rate in Chinese adults than the serum creatinine-based equation

      摘要
    • 摘要: 目的 比较基于血清胱抑素C（serum cystatin C，ScysC）公式和血肌酐（Scr）公式计算中国人群肾小球滤过率（glomerular filtration rate，GFR）的性能。方法 分析2017年7月1日至2019年7月31日期间武汉大学中南医院623例慢性肾脏病（CKD）患者临床资料，以99mTc-DTPA肾脏同位素显像后Gates法计算mGFR为标准，根据肾脏同位素显像前48小时内Scr和ScysC值分别使用CKD-EPIScr、CKD-EPIScysC、FASScr、FASScysC公式计算eGFR，比较各公式eGFR与mGFR之间的偏差、精确度、准确度；以mGFR根据2012 KDIGO指南进行CKD分期，比较eGFR与mGFR分期的一致性。结果 在整体样本、肾功能不全亚组及年龄亚组中，ScysC公式比Scr公式的偏差小且准确度高。整体样本中CKD-EPIScysC对比CKD-EPIScr偏差为-4.65 vs-10.67，P30为56.7% vs 48.8%；FASScysC对比FASScr偏差为-7.49 vs-10.16，P30为56.0% vs 51.4%。中重度肾功能不全组mGFR<60 mL·min-1·（1.73 m2）-1中CKD-EPIScysC对比CKD-EPIScr偏差为-2.23 vs-7.14，P30为57.4% vs 45.5%；FASScysC对比FASScr偏差为-6.69 vs-7.14，P30为53.0% vs 48.2%。老年人组（年龄≥70岁）中CKD-EPIScysC对比CKD-EPIScr偏差为-2.23 vs-9.13，P30为59.4% vs 41.3%；FASScysC对比FASScr偏差为-5.78 vs-6.12，P30为53.8% vs 51.0%。各公式eGFR与mGFR诊断CKD对比中，ScysC公式比Scr公式的诊断准确度高，CKD-EPIScr、CKD-EPIScysC、FASScr、FASScysC公式ROC曲线下面积分别为0.935、0.938、0.936、0.937，Kappa值分别为0.264、0.331、0.301、0.315。结论 单独基于ScysC的公式比单独基于Scr的公式计算中国人群的eGFR更加精准。

       

      Abstract: Objective To compare the performances of the serum cystain C-based equation and the serum creatinine-based equation in Chinese adults.Methods The clinical data of 623 patients with chronic kidney disease(CKD)at Zhongnan Hospital of Wuhan University(Wuhan,China)from July 1,2017 to July 31,2019 were analyzed.It was taken as the gold standard to calculate eGFR with the Gates method after 99mTc-DTPA isotope kidney imaging.The eGFR values were calculated,using the CKD-EPIScr,CKD-EPIScysC,FASScr,FASScysC equations,based on Scr and Scys C values within 48 hours before the isotope kidney imaging.Then,bias,precision and accuracy of the eGFR values from mGFR values were compared between various equations.In accordance with the 2012 KDIGO guidance,the CKD staging was performed with the mGFR values,and compliance of the eGFR with the mGFR staging results was analyzed.Results The ScysC-based equation had less bias and higher accuracy than the Scr-based equation in the overall sample and renal injury and age subgroups.In the overall group,the bias of CKD-EPIScysCvs CKD-EPIScrwas-4.65 vs-10.67,P30 was 56.7% vs 48.8%;the FASScysCvs FASScr bias was-7.49 vs-10.16 and P30 was 56.0% vs 51.4%.In the moderate to severe renal injury group,the bias of CKD-EPIScysCvs CKD-EPIScr was-2.23 vs-7.14,P30 was 57.4% vs 45.5%;the FASScysCvs FASScr bias was-6.69 vs-7.14 and P30 was 53.0% vs 48.2%.In the elderly group(age≥70),the bias of CKD-EPIScysCvs CKD-EPIScr was-2.23 vs-9.13,P30 was 59.4% vs 41.3%;the FASScysCvs FASScr bias was-5.78 vs-6.12 and P30 was 53.8% vs 51.0%.The ScysC-based equation was more accurate than the Scr-based equation in the diagnosis of CKD wih eGFR and mGFR values calculated with various equations.The areas under the ROC curve of the CKD-EPIScr,CKD-EPIScysC,FASScr and FASScysC were 0.935,0.938,0.936,and 0.937,respectively.Their kappa values were 0.264,0.331,0.301 and 0.315,respectively.Conclusions The solo ScysC-based equation is more accurate than the solo Scr-based equation to estimate the eGFR in Chinese adults.

       

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