半胱氨酸蛋白酶抑制剂C评估慢性肾脏病患者肾小球滤过功能的Meta分析

引用本文

马清光, 堵一乔, 李慧敏, 沈丽. 半胱氨酸蛋白酶抑制剂C评估慢性肾脏病患者肾小球滤过功能的Meta分析. 循证医学,2014,14(5): 291-296
MA Qing-guang, DU Yi-qiao, LI Hui-min, SHEN Li. Value of Serum Cystatin C in Evaluating Glomerular Filtration Rate in Patients with Chronic Kidney Disease： A Meta-Analysis. Journal of Evidence-Based Medicine,2014, 14(5): 291-296 复制到剪切板

Permissions

半胱氨酸蛋白酶抑制剂C评估慢性肾脏病患者肾小球滤过功能的Meta分析

马清光¹, 堵一乔², 李慧敏¹, 沈丽¹

1. 上海市大场医院检验科, 上海 200436

2. 上海曙光医院宝山分院检验科, 上海 201900

作者简介:马清光（1966-）,男,黑龙江宾县人,主任医师,医学硕士,从事循证检验医学研究工作。

摘要

目的评价半胱氨酸蛋白酶抑制剂C对慢性肾脏病患者肾小球滤过功能的诊断价值。方法检索MEDLINE、EMBASE、Cochrane 图书馆等数据库,检索时间为 1966 年至2013年6月,收集关于检测血清胱抑素C对肾小球滤过功能的诊断价值的研究文献并进行质量评价,采用Cochrane 协作网提供的RevMan 5.0软件进行异质性分析,Meta-DiSc 进行Meta 分析并绘制综合受试者工作特征曲线。结果共检索到相关文献231篇,最终纳入14篇文献,研究观察对象2 169例。Meta分析结果显示,肾小球滤过率以80~90 mL/min为诊断截点,纳入的14篇半胱氨酸蛋白酶抑制剂C诊断价值研究间的异质性不明显（P=0.10,I²=35%）;合并优势比30.71（21.70,43.46）;诊断的敏感度0.873 ,特异度0.791;综合受试者工作特征曲线下面积0.922 6。合并5篇肾小球滤过率轻度减低组（60~90 mL/min）的结果显示,文献间无异质性（P=0.71,I²=0.0%）;合并优势比7.05（4.56,10.91）;诊断的敏感度0.813,特异度0.609,综合受试者工作特征曲线下面积0.822 6。结论半胱氨酸蛋白酶抑制剂C与肾小球滤过率有良好相关性,半胱氨酸蛋白酶抑制剂C对慢性肾脏病患者肾小球滤过率诊断有较高的敏感性和特异性;慢性肾脏病患者肾小球滤过率分期研究不多,仍需要高质量的研究文献进一步验证。

关键词: 半胱氨酸蛋白酶抑制剂C; 肌酐; 肾小球滤过率; Meta分析

中图分类号:562.2 文献标识码:A

Value of Serum Cystatin C in Evaluating Glomerular Filtration Rate in Patients with Chronic Kidney Disease： A Meta-Analysis

MA Qing-guang¹, DU Yi-qiao², LI Hui-min¹, SHEN Li¹

1. Department of Laboratory Medicine,Shanghai Dachang Hospital, Shanghai 200436, China

2. Department of Laboratory Medicine, Shanghai Shuguang Hospital, Shanghai 201900 China

Abstract

Objective To evaluate the diagnostic value of Cystatin C（CysC） in glomerular filtration rate （GFR） of chronic kidney disease（CKD） patients.Methods We searched MEDLINE, EMBASE, the Cochrane Library and other databases （1966 to June 2013） to collect studies which evaluated the diagnostic value of CysC in evaluating GFR in patients with CKD. The heterogeneity of included studies was tested by the Cochrane Collaboration's software RevMan 5.0. The Summary Receiver Operating Characteristic （SROC） curve and meta-analysis were performed by Meta-DiSc.Results Total of 14 relevant articles were included in our review, with study subjects involving 2 169 patients. Meta-analysis showed that GFR（cut-off 80~90 mL/min）, the CysC heterogeneity among studies was high（P=0.10, I²=35%）, OR=30.71（21.70,43.46）, SEN=0.873, SPE=0.791,SAUC=0.922 6. Five of the studies which included various stages of GFR（60~90 mL/min）group of meta-analyses showed that CysC had no heterogeneity[P=0.71,I²=0.0%,OR=7.05（4.56,10.91）, SEN=0.813,SPE=0.609,SAUC=0.822 6].Conclusion There is significant correlation between GFR and CysC. As for early CKD, CysC has more sensitivity and specificity for estimation of GFR. Further high quality researches on various stage of CKD are still required.

Key words: Cystatin C; creatinine; glomerular filtration rate; meta-analysis

Show Figures

临床上评估肾小球滤过率（glomerular filtration rate,GFR）最常用的方法是测定血清肌酐清除率（creatinine clearance rate,CCR）,但此法受诸多因素影响。近年来,血清胱抑素C（Cystatin C,CysC）作为相对理想的内源性标志物,在评价GFR方面的作用逐步受到关注^{[ 1, 2, 3]}。许多研究结果表明,CysC是一项比血清肌酐（creatinine,Cr）更灵敏、反应肾小球滤过功能受损的血清标志物,但也有不同的观点^{[ 4, 5]}。虽然已有关于CysC评估肾小球滤过率价值的Meta分析^{[ 6, 7, 8]},但这些研究没有纳入国内研究,未进行异质性分析。我们在相关研究基础上,进一步探讨CysC评价慢性肾病（chronic kidney disease,CKD）患者GFR的价值及影响因素。

1 资料与方法

1.1 检索策略

纳入标准：电子检索MEDLINE、PubMed、EMBASE、Cochrane 图书馆、中国生物医学文献数据库、万方学术期刊数据库等（1966年至2013年6月）。中文检索词为：半胱氨酸蛋白酶抑制剂C,Cystatin C,肾小球滤过率。英文检索词为：Cystatin C, glomerular filtration rate,GFR。中文检索式为：（半胱氨酸蛋白酶抑制剂C OR “Cystatin C” OR CysC）AND （肾小球滤过率 OR “glomerular filtration rate” OR GFR）;PubMed与Cochrane 图书馆中检索式为：（“Cystatin C” OR CysC） AND （“glomerular filtration rate” OR GFR）。首先查找半胱氨酸蛋白酶抑制剂C检测对肾小球滤过率的诊断性研究文献,阅读摘要、全文。选择能提取四格表数据的诊断研究,按评价标准逐项分析。

1.2 研究类型

检测CysC评价CKD患者GFR的诊断性试验,语种限定为中、英文。

CKD诊断标准：参考美国肾病基金会公布的“改善肾病预后及生存质量的倡议”临床实践指南（NKF/K-D0QI）定义内容。

非CKD排除标准：①急性肾脏病或急性肾功能不全患者;②透析患者;③甲状腺疾病、病毒性肝炎、抗菌药物应用;④白血病、恶性肿瘤等非慢性肾脏病患者。

纳入标准：检测CysC评估CKD患者肾小球滤过率诊断性试验文献。有GFR检测的金标准或参考标准方法。观察指标有敏感度、特异度、阳性及阴性似然比、阳性和阴性预测值,或可提取四格表数据。

排除标准：非慢性肾脏病患者CysC检测的诊断性试验文献,无GFR检测的金标准或参考标准方法,无法提取四格表数据等指标。

1.3 GFR检测的参考方法

GFR检测“金标准”方法：外源性菊粉（Inulin）、碘海醇（Iohexol）或碘拉盐（¹²⁵I-iothalamate）、^99m锝-二乙烯三胺戊乙酸（^99mTc-DTPA）、⁵¹Cr-EDTA清除率。

1.4 资料提取

由两位研究者按纳入排除标准筛选文献,并按设计好的资料提取表提取资料,最后交叉核对提取情况,如遇分歧,通过讨论协商解决。文献提取的内容包括：研究对象、研究地点、样本量、参考方法、检测方法、四格表数据等。

1.5 文献质量评价

两位研究者采用Cochrane协作网提供的诊断性研究系统评价纳入研究质量评价工具QUADAS 14条^{[ 9]},对纳入研究进行评价。

1.6 Meta分析

采用Cochrane 协作网提供的RevMan5.0软件进行Meta 分析。各研究结果间的异质性采用χ²检验,如各研究间不存在统计学异质性（ P>0.10, I²<50%）,采用固定效应模型进行Meta 分析;反之则采用随机效应模型,并分析导致异质性的可能原因。对于临床异质性大、不可合并的试验结果采用描述性分析。对纳入研究采用综合受试者工作特征（summary receiver operating characteristic,SROC）曲线分析,计算合并敏感度、特异度和SROC曲线下面积。SROC曲线分析使用Meta-DiSc软件完成^{[ 10]}。

2 结果

2.1 纳入文献特点及质量评价

共检出相关文献231篇,经阅读文题和摘要,初筛出14项研究基本符合纳入标准,其中英文8篇、中文6篇,分别来自5个国家。纳入研究的设计：所有研究均为CysC评估GFR价值的诊断试验。14个研究纳入观察对象为2 169例CKD患者。文献筛选流程图见图1。按GFR分期,以一期为对照组,GFR以80 mL/min或90 mL/min为诊断截点。CysC检测方法是颗粒增强透射免疫比浊法（particle-enhanced turbidimetric immunoassay, PETIA）、颗粒增强散射免疫比浊法（particle-enhanced nephelometric immunoassay,PENIA）。所有纳入文献研究对象均具有疾病谱代表意义,方法学质量均较高。纳入研究基本情况见表1。两位研究者采用Cochrane协作网提供的诊断性研究系统评价质量评价工具QUADAS 14条^{[ 9]},对纳入研究进行评价。研究所纳入的研究对象均具有疾病谱代表意义,方法学质量均较高。

表1 纳入研究的基本情况

	Figure Option View Download New Window
	图1 文献筛选流程及结果

2.2 Meta分析结果

2.2.1 14个研究的分析结果

对纳入的14项研究进行漏斗图分析,结果显示左右基本对称,提示存在发表偏倚的可能性较小。对14个研究进行异质性分析显示异质性不明显（ P=0.10, I²=35%）;合并OR=30.71（21.70,43.46）;诊断的敏感度=0.873,特异度=0.791;SROC曲线下面积=0.922 6。见图2, 图3, 图4。

	Figure Option View Download New Window
	图2 14项研究CysC评估GFR的漏斗图

	Figure Option View Download New Window
	图3 14项研究CysC评估GFR的森林图

	Figure Option View Download New Window
	图4 14项研究 CysC评估GFR的SROC曲线

2.2.2 GFR轻度减低亚组的分析结果

5篇文献对GFR轻度减低组（60~90 mL/min）进行了亚组分析。5项研究的异质性分析显示无异质性（ P=0.71, I²=0.0%）,合并OR=7.05（4.56,10.91）,诊断的敏感度=0.813,特异度=0.609;SROC曲线下面积=0.822 6。见图5和图6。

	Figure Option View Download New Window
	图5 GFR轻度减低亚组CysC评估GFR的森林图

	Figure Option View Download New Window
	图6 GFR轻度减低亚组CysC评估GFR的SROC曲线

2.2.3 不同CysC检测方法的Meta分析

10篇文献采用PENIA法,分析结果： P=0.087, I²=40.6%,诊断的敏感度=0.884,特异度=0.790,合并OR=32.4（21.6,48.7）,SROC曲线下面积0.927 8。4篇文献采用PETIA法,分析结果： P=0.237, I²=29.2%,诊断的敏感度=0.838,特异度=0.792,合并OR=25.7（12.08,54.7）,SROC曲线下面积=0.906 0。

3 讨论

CysC由有核细胞产生,其浓度不受年龄、性别、饮食、炎症等因素的影响,是一种理想的反映 GFR变化的内源性标志物^{[ 1, 2, 3]}。很多文献报道研究CysC对GFR的诊断价值,本文纳入的14篇文献研究CysC对GFR的诊断价值,并可提取四格表数据。

多数研究以GFR（80~90 mL/min）为诊断截点,GFR大于80~90 mL/min为对照组,小于80~90 mL/min为研究组,没有对CKD患者分期。研究结果表明,CysC与金标准GFR有良好相关性,14项研究合并分析的结果显示CysC对慢性肾病GFR诊断的敏感度、特异度、诊断效能较高（敏感度=0.873,特异度=0.791,SROC曲线下面积=0.922 6）。但诊断研究间存在异质性（ P=0.10, I²=35%）, 从漏斗图形态看也存在发表偏倚。

从异质性来源看,纳入研究的GFR检测采用5种金标准方法：外源性菊粉（Inulin）、碘海醇（Iohexol）或碘拉盐（¹²⁵I-iothalamate）、^99m锝-二乙烯三胺戊乙酸（^99mTc-DTPA）、⁵¹Cr-EDTA清除率。金标准物质本身对异质性无影响,异质性差异可能与金标准GFR诊断截点的界定（80 mL/min或90 mL/min）和GFR计算方法不同有关。CysC指标检测用PENIA法、PETIA法,Meta分析表明异质性与检测方法有关;PENIA法采用德灵公司的试剂,仪器与试剂配套分析系统一致,参考范围差异较小（0.85~1.17 mg/L）。PETIA法采用Dako公司生化试剂,生化分析仪不统一,分析系统不一致,参考范围差异较大（0.89~1.43 mg/L）,所以不同仪器、试剂、校准品导致不同检测系统之间的异质性差异。从PENIA法异质性大于PETIA法看,异质性也可能来源于CysC参考值的不同取值方法,有的用SROC曲线法,有的引入文献法等,文献不多,期待更多研究的进一步验证。

GFR分期研究明显影响异质性,GFR不同分期诊断敏感度、特异度也不同。5个分期研究GFR 60~90 mL/min （敏感度=0.813,特异度=0.609,SROC曲线下面积=0.822 6）。GFR不分期的诊断效能要高于GFR分期的诊断效能,原因是不分期CKD患者中包含中晚期患者（GFR<60 mL/min）。对CKD患者应分期研究,重点研究对GFR轻度减低时（60~90 mL/min）的诊断价值。14篇文献中有5篇做了GFR分期研究^{[ 11, 12, 13, 16, 24]},合并GFR轻度减低期的5项研究显示,CysC异质性均明显减低,说明将GFR轻、中、重度的患者纳入一组研究,大大增加研究的异质性。

对照组设置不恰当也会影响研究的异质性,纳入研究均以CKD患者GFR大于80~90 mL/min为对照组,由于对照组本身也是患者,由此得出的敏感度、特异度未必真实。应以非CKD健康正常相应人群为对照组,GFR大于80~90 mL/min CKD患者也作为观察组。CysC研究重点在CKD高过滤期和早期的诊断价值,即GFR大于90 mL/min和GFR等于60~90 mL/min的两个期间,对CKD中晚期（GFR小于60 mL/min）CysC与肌酐诊断效能无明显差异。CKD患者高过滤期（GFR>90 mL/min）CysC升高,还需进一步研究。

综上所述,CysC对CKD患者GFR诊断敏感性、特异性较高,CysC文献异质性较高,仍需要高质量的评估文献。今后应注重CKD患者GFR分期研究,正确设立对照组及CysC的临界值。以期得到客观的、正确的评估结果,为临床合理应用CysC提供诊断依据。

The authors have declared that no competing interests exist.

参考文献

View Option

[1]	Harmoinen AP, Kouri TT, Wirta OR, et al. Evaluation of plasma cystatin C as a marker for glomeruler filtration rate in patients with type 2 diabetes[J]. Clin Nephrol, 1999, 52(6): 363-370. [本文引用:1] [JCR: 1.288]
[2]	Mojiminiyi OA, Abdella N. Evaluation of cystatin C and beta-2 microglobulin as markers of renal function in patients with type 2 diabetes mellitus[J]. J Diabetes Complications, 2003, 17(3): 160-168. [本文引用:1]
[3]	Aksun SA, Ozmen D, Ozmen B, et al. Beta-2microglobulin and cystatin C in type 2 diabetes: Assessment of diabetic nephropathy[J]. Exp Clin Endocrinol Diabetes, 2004, 112(4): 195-200. [本文引用:1]
[4]	Oddoze C, Morange S, Portugal H, et al. Cystatin C is not more sensitive than creatinine for detecting early renal impairment in patients with diabetes[J]. Am J Kidney Dis, 2001, 38(2): 310-316. [本文引用:1] [JCR: 5.294]
[5]	Laterza OF, Price CP, Scott MG. Cystatin C: An improved estimator of glomerular filtration rate?[J]. Clin Chem, 2002, 48(5): 699-707. [本文引用:1] [JCR: 7.149]
[6]	Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: A meta-analysis[J]. Am J Kidney Dis, 2002, 40(2): 221-226. [本文引用:1] [JCR: 5.294]
[7]	李萍, 赵莹, 余霆. 肾脏滤过功能损伤实验室诊断指标半胱氨酸蛋白酶抑制剂C的系统评价[J]. 检验医学, 2005, 20(5): 474-478. [本文引用:1]
[8]	van Pottelbergh G, van Heden L, mathei C, et al. Methods to evaluate renal function in elderly patients: A systematic literature review[J]. Age Ageing, 2010, 39(3): 542-548. [本文引用:1] [JCR: 3.816]
[9]	Whiting PF, Weswood ME, Rutjes AWS, et al. QUADAS评价: 一种用于诊断性研究的质量评价工具(修订版)[J]. 中国循证医学杂志, 2007, 7(7): 531-536. [本文引用:2]
[10]	张天嵩, 钟文昭. Meta-DiSc软件在诊断试验Meta 分析中的应用[J]. 循证医学, 2008, 8(2): 97-100. [本文引用:1]
[11]	张春梅. 胱抑素C 测定对评价2 型糖尿病肾病肾小球滤过率的价值[J]. 临床军医杂志, 2008, 36(6): 999-1000. [本文引用:1]
[12]	周游. 健康人群血清胱抑素C 的分布及其用于评价肾小球滤过率的临床研究[J]. 浙江临床医学, 2008, 10(5): 694-695. [本文引用:1]
[13]	王宏儒, 杜国伟, 鲍晓荣. 血清胱抑素C 在评价慢性肾脏病患者肾小球滤过率中的价值[J]. 中国中西医结合肾病杂志, 2010, 11(5): 421-423. [本文引用:1]
[14]	李海霞, 吴红花, 徐国宾, 等. 血清半胱氨酸蛋白酶抑制剂C与肌酐在评价糖尿病患者肾小球滤过功能中的比较研究[J]. 中华检验医学杂志, 2005, 28(6): 602-605. [本文引用:1]
[15]	李萍, 赵莹, 黄亨健, 等. 胱蛋白酶抑制剂C对肾小球滤过功能的评价[J]. 中华检验医学杂志, 2005, 28(5): 515-516. [本文引用:1]
[16]	李海霞, 张春丽, 徐国宾, 等. 健康人群血清半胱氨酸蛋白酶抑制剂C与肌酐分布及其评价慢性肾脏病患者肾小球滤过功能的比较研究[J]. 中华检验医学杂志, 2006, 29(11): 970-974. [本文引用:1]
[17]	Filler G, Priem F, Lepage N, et al. Beta-trace protein, cystatin C, beta(2)-microglobulin, and creatinine compared for detecting impaired glomerular filtration rates in children[J]. Clin Chem, 2002, 48(5): 729-736. [本文引用:1] [JCR: 7.149]
[18]	Mussap M, Dalla Vestra M, Fioretto P, et al. Cystatin C is a more sensitive marker than creatinine for the estimation of GFR in type 2 diabetic patients[J]. Kidney Int, 2002, 61(4): 1453-1461. [本文引用:1]
[19]	Chantrel F, Agin A, Offner M, et al . Comparison of cystatin C versus creatinine for detection of mild renal failure[J]. Clin Nephrol, 2000, 54(5): 374-381. [本文引用:1]
[20]	Perlemoine C, Beauvieux MC, Rigalleau V, et al. Interest of cystatin C in screening diabetic patients for early impairment of renal function[J]. Metabolism, 2003, 52(10): 1258-1264. [本文引用:1] [JCR: 3.096]
[21]	Maclsaac RJ, Tsalamand ris C, Thomas MC, et al. The accuracy of cystatin C and commonly used creatinine-based methods for detecting moderate and mild chronic kidney disease in diabetes[J]. Diabet Med, 2007, 24(4): 443-448. [本文引用:1] [JCR: 3.241]
[22]	Pucci L, Triscornia S, Lucchesi D, et al. Cystatin C and estimates of renal function: Searching for a better measure of kidney function in diabetic patients[J]. Clin Chem, 2007, 53(3): 480-488. [本文引用:1] [JCR: 7.149]
[23]	Hoek FJ, Kemperman FA, Krediet RT. A comparison between cystatin C, plasma creatinine and the Cockcroft and Gault formula for the estimation of glomerular ltration rate[J]. Nephrol Dial Transplant, 2003, 18(10): 2024-2031. [本文引用:1] [JCR: 3.371]
[24]	Spanaus KS, Kollerits B, Ritz E, et al. Serum creatinine, cystatin C, and B-trace protein in diagnostic staging and predicting progression of primary nondiabetic chronic kidney disease[J]. Clin Chem, 2010, 56(5): 740-749. [本文引用:1] [JCR: 7.149]

1999

1.288

0.0

2003

0.0

2004

0.0

2001

5.294

0.0

Oddoze

, Morange

, Portugal

, et al. Cystatin C is not more sensitive than creatinine for detecting early renal impairment in patients with diabetes[J]. Am J Kidney Dis, 2001, 38(2): 310-316.

Abstract

This study evaluated serum cystatin C as a potential new marker of glomerular filtration rate (GFR) in 49 patients who had steady-state diabetes with early renal impairment. We determined the correlation between GFR measured by chromium 51-labeled EDTA and levels of serum cystatin C, serum creatinine, serum [beta ]₂-microglobulin, endogenous creatinine clearance, and Cockcroft formula. Sensitivity and specificity for the diagnosis of renal failure, defined as a GFR less than either 80 or 60 mL/min/1.73 m², were calculated by receiver operating characteristic (ROC) curves for creatinine, cystatin C, and [beta ]₂-microglobulin. Finally, we compared mean values of these three serum parameters in patients grouped according to GFR using the two definitions of renal failure. Correlation coefficients with GFR were [minus ]0.77 for serum creatinine level, [minus ]0.65 for serum cystatin C level, [minus ]0.71 for serum [beta ]₂-microglobulin level, +0.56 for endogenous creatinine clearance, and +0.69 for Cockcroft formula (all P [lt ] 0.001). With a cutoff value of 60 mL/min/1.73 m², areas under the ROC curve were 0.972 for [beta ]₂-microglobulin, 0.925 for cystatin C, and 0.916 for creatinine levels. With a cutoff value of 80 mL/min/1.73 m², these were 0.838 for [beta ]₂-microglobulin, 0.780 for cystatin C, and 0.905 for creatinine levels (P [equals] not significant between parameters). These results were not altered after the exclusion of patients (n [equals] 8) with a serum creatinine level greater than 1.41 mg/dL. When patients were classified into three groups according to GFR (group 1, [gt ]80 mL/min/1.73 m²; group 2, 60 to 80 mL/min/1.73 m²; group 3, [lt ]60 mL/min/1.73 m²), mean values of serum parameters in the three groups were statistically different (P [lt ] 0.0001) except between groups 1 and 2 for cystatin C and [beta ]₂-microglobulin. With patients classified into two groups (GFR [gt ] or [lt ] 80 mL/min/1.73 m²), mean values for each parameter were statistically different (P [lt ] 0.001). Sensitivity, specificity, and positive and negative predictive values for serum creatinine and serum cystatin C levels were very close for both definitions of renal failure. Serum cystatin C is not better than serum creatinine or serum [beta ]₂-microglobulin levels for estimating GFR in patients with steady-state diabetes using ROC curves or other validation tests. [copy ] 2001 by the National Kidney Foundation, Inc.

2002

7.149

0.0

2002

5.294

0.0

Dharnidharka

, Kwon

, Stevens

Serum cystatin C is superior to serum creatinine as a marker of kidney function: A meta-analysis[J]. Am J Kidney Dis, 2002, 40(2): 221-226.

Abstract

Background: Serum cystatin C (Cys C) has been proposed as a simple, accurate, and rapid endogenous marker of glomerular filtration rate (GFR) in research and clinical practice. However, there are conflicting reports regarding the superiority of Cys C over serum creatinine (Cr), with a few studies suggesting no significant difference. Methods: We performed a meta-analysis of available data from various studies to compare the accuracy of Cys C and Cr in relation to a reference standard of GFR. A bibliographic search showed 46 articles until December 31, 2001. We also retrieved data from eight other studies presented and published in abstract form. Results: The overall correlation coefficient for the reciprocal of serum Cys C (r = 0.816; 95% confidence interval [CI], 0.804 to 0.826) was superior to that of the reciprocal of serum Cr (r = 0.742; 95% CI, 0.726 to 0.758; P < 0.001). Similarly, receiver operating characteristic (ROC)-plot area under the curve (AUC) values for 1/Cys C had greater identity with the reference test for GFR (mean ROC-plot AUC for Cys C, 0.926; 95% CI, 0.892 to 0.960) than ROC-plot AUC values for 1/Cr (mean ROC-plot AUC for serum Cr, 0.837; 95% CI, 0.796 to 0.878; P < 0.001). Immunonephelometric methods of Cys C assay produced significantly greater correlations than other assay methods (r = 0.846 versus r = 0.784; P < 0.001). Conclusion: In this meta-analysis using currently available data, serum Cys C is clearly superior to serum Cr as a marker of GFR measured by correlation or mean ROC-plot AUC.

2005

0.0

2010

3.816

0.0

2007

0.0

... 5 文献质量评价两位研究者采用Cochrane协作网提供的诊断性研究系统评价纳入研究质量评价工具QUADAS 14条^[9],对纳入研究进行评价 ...

... 两位研究者采用Cochrane协作网提供的诊断性研究系统评价质量评价工具QUADAS 14条^[9],对纳入研究进行评价 ...

2008

0.0

... SROC曲线分析使用Meta-DiSc软件完成^[10] ...

2008

0.0

2008

0.0

2010

0.0

2005

0.0

2005

0.0

2006

0.0

... 14篇文献中有5篇做了GFR分期研究^{[11,12,13,16,24]},合并GFR轻度减低期的5项研究显示,CysC异质性均明显减低,说明将GFR轻、中、重度的患者纳入一组研究,大大增加研究的异质性 ...

2002

7.149

0.0

2002

0.0

Mussap

, Dalla

Vestra M

, Fioretto

, et al. Cystatin C is a more sensitive marker than creatinine for the estimation of GFR in type 2 diabetic patients[J]. Kidney Int, 2002, 61(4): 1453-1461.

Kidney International aims to inform the renal researcher and practicing nephrologists on all aspects of renal research. Clinical and basic renal research, commentaries, The Renal Consult, Nephrology sans Frontieres, minireviews, reviews, Nephrology Images, Journal Club. Published weekly online and twice a month in print.

2000

0.0

2003

3.096

0.0

2007

3.241

0.0

Maclsaac

, Tsalamand ris

, Thomas

, et al. The accuracy of cystatin C and commonly used creatinine-based methods for detecting moderate and mild chronic kidney disease in diabetes[J]. Diabet Med, 2007, 24(4): 443-448.

1Endocrine Centre and Department of Medicine, University of Melbourne and Austin Health, Heidelberg West, Baker Medical Research Institute, Melbourne, 2Department of Nuclear Medicine and Centre for PET, 3Department of Laboratory Medicine and 4Department of Nephrology, Austin Health, Heidelberg, Victoria, Australia * : Dr R. J. MacIsaac, Endocrine Centre, Austin Health, Heidelberg Repatriation Hospital, Level 2, Centaur Building, 300 Waterdale Road, Heidelberg West, Victoria, 3081, Australia. E-mail: <a href="mailto:r.macisaac@unimelb.edu.au" title="Link to email address" shape="rect">r.macisaac@unimelb.edu.au</a>

Background The accuracy of measuring serum cystatin C levels for detecting various stages of chronic kidney disease (CKD) in diabetes is still unclear.

2007

7.149

0.0

2003

3.371

0.0

2010

7.149

0.0