囊素C作为功能和甲基相关毒性的预测因子,在患有类风湿性关节炎的患者中
Hyeok Chan Kwon1, Mi Il Kang2, So Mi Kim3
1H.C. Kwon, MD, Division of Rheumatology, Department of Internal Medicine, Dankook University College of Medicine.
The Journal of rheumatology
|October 1, 2023
概括
在类风湿性关节炎患者中,估计的淋巴膜过率 (eGFR) 经常被高估,使用血清肌素. 使用囊素C进行eGFR计算显示,更多患者需要进行甲状腺素剂量调整,导致毒性风险增加.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 类风湿病学 类风湿病学
- 临床化学 临床化学
背景情况:
- 甲托雷克萨特 (MTX) 是一种主要治疗类风湿性关节炎 (RA) 的药物.
- 功能显著影响MTX的有效性和安全性.
- 精确估计膜过率 (eGFR) 对于适当的MTX剂量至关重要.
研究的目的:
- 调查血清肌素 (SCr) 和囊素C之间的eGFR估计差异.
- 评估这些差异对MTX剂量和RA患者相关毒性的影响.
主要方法:
- 使用CKD-EPI方程与SCr和cystatin C计算436名RA患者的eGFR.
- 根据eGFR将患者分为CKD和MTX的剂量阶段.
- 评估了MTX相关的毒性,包括贫血,白血病和毒性.
主要成果:
- 使用囊素C (CKD-EPIcys) 计算的eGFR比使用SCr (CKD-EPISCr) 计算的低.
- 近30%的患者根据CKD-EPIcys被重新分类到更高的CKD阶段.
- 6.4%的患者由于重新分类到较低的eGFR阶段,需要MTX剂量调整.
- 在患者中观察到的MTX毒性的发病率增加,其CKD阶段基于cystatin C变化.
结论:
- 与囊素C相比,基于血清肌素的eGFR往往会高估RA患者的功能.
- 使用cystatin C对eGFR的重新分类会影响MTX的剂量建议.
- 在eGFR分期的变化与MTX相关毒性显著更高的风险相关.
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