Tshooj 1: Kev kwv yees ntawm lub raum ua haujlwm hauv cov neeg mob uas muaj kab mob hauv lub cev tseem ceeb: Puas yog Serum Cystatin Ca zoo dua rau lub raum ua haujlwm dua li Creatinine?
Jun 06, 2022
Yog xav paub ntxiv. tiv taujtina.xiang@wecistanche.com
Abstract
Keeb kwm: Kev siv cov ntshav creatinine ua rau muaj kev kwv yees ntau dhaulub raum ua haujlwmnyob rau hauv cov neeg mob uas muaj thawj neuromuscular teeb meem, thiab txo lub raum ua hauj lwm yuav nyob twj ywm undetected. Cystatin C (CysC) tuaj yeem muab kev kwv yees zoo dua.
Hom phiaj: Txhawm rau ntsuas qhov tseeb, qhov tseeb, thiab kev tsis ncaj ncees ntawm ob lub creatinine-, ib qho cystatin C-raws li thiab ib qho sib xyaw ua ke los kwv yees glomerular filtration rate (eGFR) hauv cov neeg mob thawj zaug.kab mob neuromuscular.
Cov neeg mob thiab cov txheej txheem Ntawm 418 tus neeg mob pib pom ntawm qhov chaw kho mob sab nraud, cov ntaub ntawv ntawm lub raum ua haujlwm tau txais rau 145 cov neeg laus (hnub nyoog 46 ± 14 xyoo, BMI 26 ± 6 kg / m²) nrog thawj cov kab mob neuromuscular. Lub raum ua haujlwm tau ntsuas los ntawm iohexol tshem tawm, thiab kuaj ntshav rau cov ntshav creatinine thiab CysC tau kos ib txhij. Bias tau txhais tias qhov txawv nruab nrab ntawm eGFR thiab ntsuas iohexol clearance thiab raug raws li qhov feem ntawm eGFRs nyob rau hauv ± 10 feem pua (P10) ntawm kev ntsuas clearance.
Cov txiaj ntsig: Lub raum ua haujlwm (iohexol tshem tawm) yog 81 ± 19 (38-134) ml/min/1.73m². Tag nrho cov kev sib npaug overestimated raum kev ua haujlwm los ntawm 22-60 ml / min / 1.73m².eGFR CysC muaj qhov qis tshaj qhov tsis ncaj ncees tag nrho 22 (95 feem pua CI 20-26) ml / min / 1.73m' kuj nyob rau txhua theem ntawm lub raum ua haujlwm peb ntsuas (ntawm 30-59 ml / min / 1.73m²bias yog 27 (95 feem pua CI21-35), ntawm 60-89nws yog 25 (95 feem pua CI 20-28) thiab ntawm 90 nws yog 12 (95 feem pua CI 7-22)).eGFR CysC kuj muaj qhov raug zoo tshaj plaws hauv cov neeg mob uas txo lub raum ua haujlwm (P10 yog 5.9 feem pua ntawm 30-59 ml / min / 1.73m²).
Cov lus xaus: Cystatin C-raws li kev kwv yees ntawm lub raum kev ua haujlwm tau zoo dua li cov creatinine-based nyob rau hauv cov neeg mob uas muaj tus kab mob tseem ceeb neuromuscular. Tseem, qhov tseem ceeb tshaj plaws, tag nrho cov kev sib npaug sib npaug overestimated raum ua haujlwm., tshwj xeeb tshaj yog cov neeg mob uas txo lub raum ua haujlwm. Yog li ntawd, lub raum kev ua haujlwm yuav tsum tau ntsuas los ntawm cov txheej txheem kub thaum xav tau qhov tseeb thiab qhov tseeb.
Nyem qhov no kom paub seb cistanche siv rau dab tsi
Taw qhia
Glomerular pom tus nqi(GFR) yog ib tug validated marker ntawm lub raum kev ua hauj lwm [1, 2] pom zoo nyob rau hauv cov lus qhia kho[3, 4]. Hauv cov neeg mob uas muaj cov kab mob neuromuscular, cov leeg nqaij poob qis, thiab yog li kev kwv yees creatinine-raws li systematically overestimate raum ua haujlwm thiab txo lub raum ua haujlwm yuav tsis raug kuaj pom thiab tsis kuaj pom [5,6]. Thaum cov ntshav creatinine ua ke nrog cov ntaub ntawv ntawm lean lub cev, kev kwv yees me ntsis zoo dua tau ua tiav [7]. Cystatin C (CysC) sib raug zoo nrog kev tshem tawm ntawm inulin, 5Cr-EDTA, thiab iohexol, thiab tsis cuam tshuam los ntawm cov leeg nqaij mus rau tib yam li creatinine [8,9] thiab yog li ntawd tau pom zoo tias yog qhov cim zoo ntawm lub raum. function[10-12]. CysC tau raug soj ntsuam hauv cov neeg mob sib txawv, tab sis ob peb txoj kev tshawb fawb tau soj ntsuam CysC hauv cov neeg mob uas muaj cov kab mob tseem ceeb hauv cov kab mob xws li Duchenne muscular dystrophy (DMD) [13,14], amyotrophic lateral sclerosis (ALS) [15], thiab myotonic dystrophy type 1( DM1) [16]. Cov kev tshawb fawb tsis ntev los no tau pom tias CysC cov ntsiab lus cuam tshuam los ntawm kev txiav txim siab dua li lub raum ua haujlwm thiab cov leeg nqaij. Hnub nyoog, txiv neej poj niam txiv neej, lub cev qhov Performance index (BMI), rog rog, triglycerides, kub siab, uric acid, C-reactive protein, thiab ntshav qab zib muaj tag nrho cov txuam nrog ntau dua cov ntshav concentration ntawm CysCregardless ntawm lub raum ua haujlwm [12,17]. Qhov no yog qhov tseem ceeb vim tias cov neeg mob uas muaj cov leeg nqaij dystrophy feem ntau muaj qhov tseeb lossis cov txheeb ze nce hauv lub cev rog [18,19]. Kev kho mob nrog cov koob tshuaj ntau ntawm glucocorticoids, nrog rau cov thyroid tsis ua haujlwm thiab haiv neeg kuj cuam tshuam rau CysC lev-els[10-12]. Ib tsab ntawv ceeb toom los ntawm Swedish Council on Health Technology Assessment qhia tias cystatin C-raws li qhov sib npaug tsis tau raug soj ntsuam txaus rau cov neeg mob uas muaj BMI tsawg [20].
Txoj kev tshawb no tau tsim los ntsuas qhov tseeb, qhov tseeb, thiab kev tsis ncaj ncees ntawm ob lub creatinine-, ib qho cystatin C-raws li thiab ib qho kev sib xyaw ua ke los kwv yees glomerular filtration rate (eGFR) hauv cov neeg mob uas muaj cov kab mob hauv lub paj hlwb. Cov kev tshawb pom kuj tseem muaj txiaj ntsig rau cov neeg uas muaj cov leeg nqaij qis lossis BMI vim lwm yam laj thawj [21].
Cov neeg mob thiab cov txheej txheem
Cov neeg mob
Tawm ntawm 418 tus neeg laus cov neeg mob tau kuaj pom thawj cov kab mob neuromuscular ntawm Neuromuscular Center ntawm Sahlgrenska University Tsev Kho Mob, Gothenburg, 314 tau hais kom koom nrog hauv txoj kev tshawb no, 153 tus neeg mob tau txais kev koom tes thiab thaum kawg, 145 cov neeg mob (68 tus txiv neej thiab 77 tus poj niam) tau. suav nrog hauv txoj kev tshawb fawb thiab lawv lub raum ua haujlwm tau raug soj ntsuam. Ib daim ntawv qhia qhia txog kev nrhiav neeg ua haujlwm ntawm cov neeg koom nrog kev kawm tau qhia hauv daim duab 1. Feem ntau ntawm cov neeg mob (n=94) muaj DM1,19 muaj Facioscapulohumeral muscular dystrophy (FSHD), 15 muaj Limb-girdle muscular dystrophy (LGMD), thiab kaum ib muaj Spinal muscular atrophy (SMA), peb muaj DMD thiab peb muaj Becker muscular dystrophy (BMD). Cov txheej txheem suav nrog yog: hnub nyoog tshaj 18 xyoo thiab muaj tus kab mob tseem ceeb neuromuscular. Qhov txo qis hauv cov leeg nqaij muaj zog los ntawm qhov ze li ib txwm muaj zog mus rau qhov tsis muaj zog, tsis suav nrog cov neeg siv lub rooj zaum muaj log thiab cov neeg mob uas xav tau kev pab ua pa nrog Bilevel Positive Airway Pressure (BiPAP), txawm li cas los xij, cov neeg mob uas muaj mob hnyav ua rau txoj kev tshawb fawb tsis yooj yim lossis ua tsis tau. cais. Cov txheej txheem cais tawm yog: kwv yees muaj sia nyob tsawg dua 1 xyoos, paub kab mob plawv ischemic, malignancy, lossis kho tsis tau cov kab mob endocrine. Tsis tas li ntawd, cov neeg mob suav nrog yuav tsum tsis txhob muaj keeb kwm yav dhau los ntawm kab mob raum lossis txo lub raum ua haujlwm. Ob tus neeg mob tau txais cov tshuaj txuas ntxiv nrog corticosteroids tsis suav nrog. Cov neeg mob tau suav nrog hauv txoj kev tshawb fawb ntawm 1st Lub Kaum Hli 2010 thiab 31st Lub Ib Hlis 2014. Txoj kev tshawb fawb tau pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Ncaj Ncees ntawm Gothenburg, Sweden (DNR 492-10). Cov txheej txheem kawm tau ua raws li cov hauv paus ntsiab lus ntawm Kev Tshaj Tawm ntawm Helsinki thiab sau ntawv tso cai tau txais los ntawm txhua tus neeg koom.
Cov txheej txheem
Kev kuaj ntshav rau kev soj ntsuam cov ntshav creatinine thiab cystatin C tau kos ib txhij thaum iohexol plasma clearance tau ua. Kev ntsuas lub raum ua haujlwm (kev tshem tawm) tau txiav txim siab los ntawm plasma-clearance ntawm iohexol(Bis(2,3-dihydroxy propyl))-5-[N-(2,3-dihydroxy propyl)-aceta-mido ]-2,4,6-triode-isophthalamide) raws li cov txheej txheem niaj hnub. Tsib.0 mL ntawm iohexol(Omnipaque⑧ 300mg J/mL, Nycomed) tau muab tso rau hauv cov hlab ntsha. Tom qab 4 ha thib ob cov ntshav kuaj tau kos los ntawm contralateral caj npab rau kev soj ntsuam ntawm iohexol concentration. Kev faib tawm ntim tau kwv yees siv lub luag haujlwm ntsig txog lub cev qhov hnyav, thiab lwm txoj hauv kev tau siv los kho qhov tsis muaj kev sib faib ua tiav thiab tsis sib xyaw tam sim. Kev tshuaj xyuas thiab kev suav ntawm iohexol tshem tawm tau ua nyob rau ntawm Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob ntawm Sahlgrenska University Tsev Kho Mob / Mölndal. Lub chaw haujlwm no koom nrog hauv kev sib piv cov qauv sib piv los ntawm Equalis thiab tau lees paub (https:/www.equalis. se/en/). Iohexol concentration tau txiav txim los ntawm HPLC [22,23] nrog rau nruab nrab hnub Coefficient ntawm variation (CV) ntawm 2.6 feem pua. IDMS-calibrated serum creatinine thiab cystatin C concentrations tau soj ntsuam siv Cobas system (Roche) ntawm Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob ntawm Sahlgrenska University Tsev Kho Mob. TheCV rau creatinine thiab Cystatin C txoj kev yog tsawg dua 5 feem pua hauv qhov ntau ntawm cov neeg mob no.
Cov indexed eGFRs (ml / min / 1.73m2) tau suav nrog cov kab zauv hauv qab no:
Unindexed raum kev ua haujlwm (clearance) thiab eGFRs (ml / min) tau suav nrog cov lej hauv qab no:
GFR (ml / min) {{0}} txheeb ze GFR [ml/min/lub cev thaj tsam (1.73 m²)】 × lub cev nto (m²) / 1.73 (m²) thiab cheeb tsam ntawm lub cev (BSA) raug xam nrog cov qauv DuBois thiab DuBois; lub cev cheeb tsam (m') =0.20247 × ntev (m) 0.725 × hnyav (kg) 0.425 [27].
Cov txheej txheem txheeb cais
Cov ntaub ntawv txuas mus ntxiv yog qhia raws li qhov txhais tau tias (SD) yog parametric thiab raws li qhov nruab nrab (interquartile range (IQR)) yog tias tsis yog parametric siv Shapiro-Wilks test rau normality. Kev sib raug zoo ntawm kev kwv yees (eGFR) thiab ntsuas kev tshem tawm tau ua tiav siv ob qho tib si sib txawv thiab ntau qhov sib txawv ntawm Spearman qhov kev txheeb xyuas kev sib raug zoo. p nyob rau hauv cov ntawv nyeem thiab cov ntxhuav yog Spearman tus rank correlation coefficient. Hauv kev txheeb xyuas ntau yam sib txawv, kho cov poj niam txiv neej, hnub nyoog, kev haus luam yeeb, thiab cov leeg nqaij [skeletal leeg index; (SMD], ib nrab Spearman's Rho method tau siv thiab p yog ib feem ntawm qhov sib txuas coefficient. clearance), nrog rau qhov tsis zoo uas qhia tias qis dua eGFR dua li ntsuas lub raum ua haujlwm (underestimation) thiab cov txiaj ntsig zoo uas qhia txog kev kwv yees ntau dhau. Qhov tseeb tau txhais raws li qhov feem ntawm eGFRs hauv ± 30 feem pua (P30) thiab ± 10 Qhov feem pua (P10) ntawm kev ntsuas clearance.Qhov 95 feem pua kev ntseeg siab ncua sij hawm (95 feem pua CIs) raug xam raws li kev ntsuas ntawm sta-tistical uncertainty thaum kwv yees kev tsis ncaj ncees thiab raug siv bootstrap nrog 1000replications, uas muab kev kwv yees zoo ntawm kev ntseeg siab intervals. P30 thiab P10 tau raug soj ntsuam nyob rau hauv kev sib raug rau lub raum ua haujlwm theem ntawm 30-59, 60-89, thiab Ntau dua lossis sib npaug li 90 ml / min / 1.73m² (26). tau txiav txim nrog rau kev sib tw kos npe rau kev tsis ncaj ncees. McNemar qhov kev xeem tiag tiag rau kev sib raug zoo ntawm P30 thiab P10 tau siv rau kev sib piv ua ke. Daim duab Bland-Altman tau siv los piav qhia txog kev tsis ncaj ncees thiab cov kev txwv ntawm kev pom zoo [28].Nyob rau hauv cov duab kos, cov txheej txheem siv, egmeasured clearance (tsis yog qhov txhais tau tias ntawm ob txoj kev) yog qhia ntawm x-axis. Txoj hauv kev no tau raug pom zoo thaum ib qho ntawm ob txoj hauv kev tuaj yeem suav tias yog qhov tseeb dua [29], tab sis qhov no kuj tau tawm tsam los ntawm Stevens li al. vim clearance kuj yog ntsuas nrog yuam kev. P-tus nqi ntawm Tsawg dua lossis sib npaug rau 0.05 tau suav tias yog qhov tseem ceeb. MedCalc(MedCalc Software, Broekstaat 52, 9030 Mariakerke, Belgium) thiab IBM SPSS Statistics 22.0 (IBM Corporation, 1 New Orchard Road, Armonk, New York 10504-1722, US) software tau siv rau kev tshuaj xyuas.
