摘要
目的探讨血清胱抑素C(Cys C)与血肌酐(Scr)及其估算公式在评价老年住院患者肾功能损伤中的差异。方法选取2015年1月至2020年1月在本院采用Tc-99m-DTPA双血浆法进行肾小球滤过率(GFR)检测的438例住院患者的临床资料。根据患者的性别分为男性组(281例)和女性组(157例)。根据患者的年龄分为65~79岁组(299例)和≥80岁组(139例)。比较组间的误判率、阳性检出率,曲线下面积(AUC)、灵敏度、特异度、约登指数、阳性似然比、阴性似然比、精确度和准确性等指标。同时对指南推荐的CKD-EPI_(Scr)、CKD-EPI_(Cys C)和CKD-EPI_(Combi)公式进行比较。结果在所有患者中,Cys C的AUC、灵敏度、特异度、约登指数、阳性似然比、阴性似然比方面均高于Scr。Cys C对肾功能损伤的误判率低于Scr,差异有统计学意义(P=0.003)。男性组的Cys C诊断价值分析优于Scr,误判率低于Scr(P=0.033);女性组的Cys C诊断价值分析与Scr相当(P>0.05),但Cys C误判率低于Scr(P=0.049)。65~79岁组的Scr诊断价值分析优于Cys C(P<0.05),但误判率比较,差异无统计学意义(χ^(2)=2.361,P=0.124);≥80岁组中Scr的AUC、灵敏度、特异度、约登指数比Cys C差,但Scr的误判率明显高于Cys C(P<0.05)。在总体、性别、年龄分组中,与CKD-EPI_(Cys C)和CKD-EPI_(Combi)相比,CKD-EPI_(Scr)的偏差最小(P<0.05)。Scr和Cys C联合公式的精确度和准确性都优于单一公式。结论Cys C在评估老年人患者的肾功能诊断优于Scr,尤其是高龄女性患者。在临床上单用Scr评估老年人肾功能准确性低,将Cys C联合Scr诊断肾功能优于单一指标。
Objective To investigate the difference between serum cystatin C(Cys C)and creatinine(Scr)in the evaluation of renal impairment in hospitalised elderly patients using glomerular filtration rate(GFR)measured by Tc-99m-DTPA double plasma method as a reference standard.Methods The clinical data of 438 hospitalized patients who underwent GFR measurement by Tc-99m-DTPA double plasma method in our hospital from January 2015 to January 2020 were selected.According to the gender of the patients,they were divided into male group(281 cases)and female group(157 cases).According to the age of the patients,they were divided into 65-79 years old group(299 cases)and≥80 years old group(139 cases).In this study,misclassification rate,positive detection rate,area under the curve(AUC),sensitivity,specificity,Jorden′s index,positive likelihood ratio,negative likelihood ratio,precision and accuracy were used for comparison.At the same time,the performance of the CKD-EPI_(Scr),CKD-EPI_(Cys C)and CKD-EPI_(Combi)equations recommended by guidelines was compared.Results In all patients,Cys C had a higher AUC,sensitivity,specificity,Youden index,positive likelihood ratio,and negative likelihood ratio than Scr.The misjudgment rate of Cys C for renal dysfunction was lower than that of Scr,and the difference was statistically significant(P=0.003).In the male group,the diagnostic value of Cys C was better than that of Scr,and the misjudgment rate was lower than that of Scr(P=0.033).In the female group,the misjudgment rate of Cys C was lower than that of Scr(P=0.049).The diagnostic value of Scr was better than that of Cys C in the group of 65-79 years old(P<0.05).In the≥80 years old group,the AUC,sensitivity,specificity and Youden index of Scr were worse than those of Cys C,but the misclassification rate of Scr was significantly higher than that of Cys C(P<0.05).Compared with CKD-EPI_(Cys C)and CKD-EPI_(Combi),the bias of CKD-EPI_(Scr)was the smallest in overall,gender and age groups(P<0.05).The precision and accuracy of Scr and Cys C combined formula were better than those of single formula.Conclusions Cys C is superior to Scr in the evaluation of renal function in elderly patients,especially in female elderly patients.In clinical practice,the accuracy of using Scr alone to evaluate renal function in the elderly is low,and the combination of Cys C and Scr is superior to a single index in the diagnosis of renal function.
作者
夏方肖
郝文科
梁锦秀
余枫
胡文学
吴燕华
方晓武
刘伟
Xia Fangxiao;Hao Wenke;Liang Jingxiu;Yu Feng;Hu Wenxue;Wu Yanhua;Fang Xiaowu;Liu Wei(Department of Nephrology,Guangdong Provincial People′s Hospital,Guangzhou 510080,China;The Second Clinical Medical College of Southern Medical University,Guangzhou 510515,China)
出处
《国际泌尿系统杂志》
2023年第3期407-411,共5页
International Journal of Urology and Nephrology
基金
广东省自然科学基金项目(2018A0303130251)
华南理工大学中央高校基本科研业务费专项资金(2018MS26)。
