| ObjeetiveThe kidney transplantation is a valid treatment eventually in last phase for kidney disease.Acute reject reaction and chronic reject reaction or medicine to cause a kidney toxicity is the familiar complications after kidney transplantation. Therefore the accurate evaluation transplantation kidney function has very important meaning in time. Only in advance understanding the variety of kidney function then can regulate use of immunity depressant to avoid transplantation organ crocking up.The Glomerular Filtration rate(GFR) is the important index sign which estimates kidney function. The routine method in the clinical is to adopt CCr, SCr, BUN etc. as a valuation GFR parameters.But some kidney factors and not-kidney factors can interfere these parameters.Furthermore the kidney contains strong ability of storage and compensation. Once was Glomerular Filtration Rate to decline to one third of normal, a lot of parameters still can be at normal scope. As a result blind spot reside in examining the item evaluation GFR. Serum CystatinC can freely filtered in the glomerules and can not be reabsorbed and secreted in renal tubule. Furthermore its density is free from sex, age, inflammatory reaction, the tumor, muscle activity, food absorb etc.So serum CystatinC is an excellent parameter which can reflect the glomerula filtration function ideally. The aim of this article is to evaluate the clinical value of serum CystatinC and Cystatin C-Based equations in the chronic kidney disease (kidney transplantation) patients with renal impairment. In order to offer a convenient and accurate sensitive index which Can reflect the GFR for the clinical kidney transplantation simple.MethodThe study objects is separated to normal groups and kidney transplantation groups.36 health persons were selected as control group.18 patients were male, 18 paitients were female. To selected 36 kidney transplantation patients who were treated in kidney medical department of General Hospital of Jinan Military ostoperative one month Region from October in 2006 to September in 2008, all sample fit the 19 patients were male,17 paitients were female. The average of ages is 42.7±16 (years). ABO blood type have been a homology or mutually match between acceptors and donators before the operation. Panel reaction antibody(PRA) all is a negative;Lymphocytotoxic cross match test(LMC) is 1%～5%. Normal regulations triple immunosuppressive after the operation: Pred+MMF+FK506The standard dual plasma sampling 99mTc-DTPA clearance was considered to be a Gold Standard, The correlation between GFR and the two parameters (CysC and Scr)were compared, the data was applied to GFR-estimating equations from Hoek,Filler,Ruijinm to observe the performances of equations compared with rGFR:difference precision and accuracy. All data was expressed as average±standard deviation(χ±s), the compare between two groups with T-test, The correlation adopt linear regression, SPSS plots showing the disagreement between equations and rGFR. p<0.05 was significantly different, analysed with SPSS statistical software ver.17.0.Result1.The range of the CysC reference value was 0.36～1.30mg/L in normal group. Transplantation's CystatinC reference of the set is worth the scope 0.62～2.66 mg/L.Both mean T examinations, p<0.01 have covariance to learn meaning, the CystatinC density in earlier period wants after the kidney transplantation is higter than in normal group.2.The detected results of CysC,Scr and rGFR (Figla,b,c)The two parameters all have correlation with rGFR, the correlation coefficient r=-0.885(P<0.01),r=-0.716(P<0.01), the correlation degree between CysC with rGFR was most intimate, showing significant statistical significance (p<0 .01).3.1 The performance of three GFR-estimating equations compared each other(Fig2a,b,c) Three GFR-estimating equations have correlation with rGFR. The correlation coefficient (Hoek equation Filler equation,Ruijin equation) r=0.835(P<0.01),r=0.829(P<0.01),r=0.769(P<0.01), the correlation degree between Hoek equation with rGFR was most intimate, showing significant statistical significance(p<0.013.2 The bias:Hoek equation< Filler equation< Ruijin equation. Detailed result Hoek equation=1424 arbitrary unit, Filler equation=1495 arbitrary unit, Ruijin equation=1798 arbitrary unit. (Fig3a,b,c)3.3 The precisions:Hoek equation>Filler equation>Ruijin equati on. Detailed result Hoek equation=27.9ml/min/1.73m2, Filler equation= 31.3ml/min/1.73m2, Ruijin equation=31.2ml/min/1.73m2.3.4 The accuracy:The rGFR±10 and 30% accuracy of Hoek Improved than Filler and Ruijin,was comparable among the three equations. Detailed result Hoek equation (47.2%,92.2%), Filler equation (30.6%,72.2%), Ruijin equation (25.0%,75.0%).Conclusion1.CystatinC is a satisfactory parameter which can reflect the glomerular filtration function, the CystatinC density in earlier period after the kidney transplantation is higter than in normal group.2.Compared with other equations, the Hoek equation is more efficient to evaluate the GFR and is recommend to clinical usage.3. Estimation of Glomerular Filtration Rates is a kind of simple, practical and economic valid method towards predicting a transplantation kidney function, easy to clinical expansion applied. |
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