CysC和RBP水平评价血清肌酐参考范围的截断值研究
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摘要
目的探讨血清胱抑素C(CysC)和视黄醇结合蛋白(RBP)水平评价血清肌酐(Scr)参考范围调整的临床价值。方法对重庆医科大学附属第二医院2017年12月21日至2018年4月25日体检中心20 126例病例Scr测定情况进行回顾性分析,1 874例同时有Scr和CysC结果,对372例按照WS/T 404参考区间(新参考区间)Scr升高但无CysC结果的样本重新测定CysC和RBP。结果新参考区间更加适用于临床95%置信区间。采用CysC升高为评价肾损伤的参考方法,以新参考区间为截断值时,Scr阳性与CysC阳性差异有统计学意义(χ~2=198.648,P=0.000);以132.3μmol/L(旧参考区间上限)为截断值时,Scr阳性与CysC阳性差异有统计学意义(χ~2=82.337,P=0.000)。以新参考区间为截断值的Scr与CysC的相关性较旧参考区间更好。当Scr>108μmol/L时,RBP才出现升高,存在正相关。结论新参考区间的截断值更加有助于临床辅助诊断。
Objective To investigate the clinical value of CysC and RBP levels for evaluating the adjustment of the serum creatinine reference range.Methods The serum creatinine detection situation of 20 126 cases in the Second Affiliated Hospital of Chongqing Medical University from December 21,2017 to April 25,2018 was retrospectively analyzed,in which 1 874 cases simultaneously had serum Scr and CysC detection results,and 372 cases with Scr increaing but without CysC results redetected the CysC and RBP levels according to the new reference range of WS/T 404.Results The new reference range was more suitable for clinical 95%confidence range.By adopting the CysC level increasing as the reference method for evaluating the renal injury and new reference interval as the cut-off value,the difference in Scr and CysC positive had statistical significance(χ~2=198.648,P=0.000).When with 132.3μmol/L(old reference interval)as the cut-off value,the difference in Scr and Cys C positive was statistically significant(χ~2=82.337,P=0.000).With the new reference interval as the cut-off value,the correlation between Scr and CysC was better than the old reference interval.When Scr>108μmol/L,RBP appeared increasing and showed the positive correlation.Conclusion The cut-off value of new reference interval is more conducive to clinical auxiliary diagnosis.
Objective To investigate the clinical value of CysC and RBP levels for evaluating the adjustment of the serum creatinine reference range.Methods The serum creatinine detection situation of 20 126 cases in the Second Affiliated Hospital of Chongqing Medical University from December 21,2017 to April 25,2018 was retrospectively analyzed,in which 1 874 cases simultaneously had serum Scr and CysC detection results,and 372 cases with Scr increaing but without CysC results redetected the CysC and RBP levels according to the new reference range of WS/T 404.Results The new reference range was more suitable for clinical 95%confidence range.By adopting the CysC level increasing as the reference method for evaluating the renal injury and new reference interval as the cut-off value,the difference in Scr and CysC positive had statistical significance(χ~2=198.648,P=0.000).When with 132.3μmol/L(old reference interval)as the cut-off value,the difference in Scr and Cys C positive was statistically significant(χ~2=82.337,P=0.000).With the new reference interval as the cut-off value,the correlation between Scr and CysC was better than the old reference interval.When Scr>108μmol/L,RBP appeared increasing and showed the positive correlation.Conclusion The cut-off value of new reference interval is more conducive to clinical auxiliary diagnosis.
引文
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[9]陈巧红,范世珍,陈珊珊.血清胱抑素C和尿微量清蛋白对糖尿病肾病的诊断意义研究[J].国际检验医学杂志,2016,37(21):3078-3079.
[10]冯国绪,程佳,谭琴,等.肾功能正常人群血清胱抑素C水平随年龄增加的变化规律分析[J].国际检验医学杂志,2018,39(9):1141-1144.
[11]陆冰,刘洲,王俊贤,等.不同分级脑白质疏松症患者血清胱抑素C水平的临床意义[J].浙江医学,2018,40(10):1091-1093,1098.
[12]MAKIN S D,COOK F A,DENNIS M S,et al.Cerebral small vessel disease and renal function:systematic review and Meta-Analysis[J].Cere Dis,2015,39(1):39-52.
[2]WEIR M R.Improving the estimating equation for GFR-A clinical perspective[J].N Engl J Med,2012,367(1):75-76.
[3]KOSTRUBIEC M,?ABYK A,PEDOWSKA-W?OSZEK J,et al.Neutrophil gelatinase-associated lipocalin,cystatin C and eGFR indicate acute kidney injury and predict prognosis of patients with acute pulmonary embolism[J].Heart,2012,98(16):1221-1228.
[4]MURTY M S,SHARMA U K,PANDEY V B,et al.Serum cystatin C as a marker of renal function in detection of early acute kidney injury[J].Indian J Nephrol,2013,23(3):180-183.
[5]郝雅娟,赵志兰,邱斌建.不同年龄性别健康体检者血清CysC水平的比较[J].中国基层医药,2016,23(9):1405-1408.
[6]江翠,逯心敏,胡孝彬.宜宾地区健康儿童血清胱抑素C参考区间的建立[J].检验医学与临床,2016,13(8):1016-1017,1019.
[7]吴丹,关硕,李论.血清胱抑素C检测在2型糖尿病肾病早期诊断中的临床价值[J].中国当代医药,2016,23(2):39-41,46.
[8]项国谦,陶晓薇,冯迪英,等.血清胱抑素C在糖尿病肾病早期诊断中的临床价值[J].中国中西医结合肾病杂志,2011,12(10):901-902.
[9]陈巧红,范世珍,陈珊珊.血清胱抑素C和尿微量清蛋白对糖尿病肾病的诊断意义研究[J].国际检验医学杂志,2016,37(21):3078-3079.
[10]冯国绪,程佳,谭琴,等.肾功能正常人群血清胱抑素C水平随年龄增加的变化规律分析[J].国际检验医学杂志,2018,39(9):1141-1144.
[11]陆冰,刘洲,王俊贤,等.不同分级脑白质疏松症患者血清胱抑素C水平的临床意义[J].浙江医学,2018,40(10):1091-1093,1098.
[12]MAKIN S D,COOK F A,DENNIS M S,et al.Cerebral small vessel disease and renal function:systematic review and Meta-Analysis[J].Cere Dis,2015,39(1):39-52.