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在老年患者中基于肌氨酸的eGFR的有效性值得怀疑,但cystatin C在一线诊断中很有帮助
Dario Geißer1, Lina Hetzel2, Ralf Westenfeld2
1Central Institute of Clinical Chemistry and Laboratory Diagnostics, Medical Faculty, Heinrich Heine University and University Hospital, 40225 Düsseldorf, Germany.
Geriatrics (Basel, Switzerland)
|December 22, 2023
概括
对于老年患者,基于肌素的估计球过率 (eGFR) 可能会高估功能. 基于cystatin C的eGFR (CAPA) 提供了一个更准确的第一线诊断测试,用于评估慢性病 (CKD) 在这个人群中.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 临床化学 临床化学
- 老年医学 老年医学
背景情况:
- 目前的慢性病 (CKD) 诊断依赖于基于肌素的估计球透率 (eGFR).
- 基于Cystatin C的eGFR可能在评估功能时提供更好的准确性.
研究的目的:
- 为了比较肌素衍生的eGFR与老年患者的cystatin C衍生的eGFR的诊断性能.
- 评估基于囊素C的eGFR对60岁以上个体的CKD分类的影响.
主要方法:
- 对112名60岁以上的医院患者进行了回顾性分析.
- 使用CKD-EPI (基于肌素) 和CAPA (基于cystatin C) 公式计算的eGFR的比较.
- 对慢性脏病的最终病例诊断的准确性评估.
主要成果:
- 基于赛斯塔丁C的eGFR (CAPA) 总是比基于肌素的eGFR (CKD-EPI) 产生较低的值,平均下降20%.
- 在37%的病例中发生了CKD重新分类,其中49%显示基于cystatin C的较低CKD阶段.
- 最初被归类为"无CKD"的患者中有很大一部分使用CAPA被重新归类为功能不足状态.
结论:
- 基于肌的eGFR (CKD-EPI) 系统地高估了60岁以上患者的功能.
- 推基于Cystatin C的eGFR (CAPA) 作为首选的第一线诊断测试.
- 使用囊素C可以提高老年人CKD诊断和病期的准确性.
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