小柯机器人

英国格拉斯哥大学Jennifer S. Lees团队研究提出，通过不同措施测定肾小球滤过率，以预测血管疾病（CVD）死亡率和终末期肾脏疾病。2019年11月7日，《自然—医学》在线发表了这一成果。

他们对估计肾小球滤过率（eGFR）的三个公式进行了测试，以确定哪个对预测CVD和死亡率最具有临床意义。使用来自英国生物银行的440,526名参与者的数据，使用血清肌酐，半胱氨酸蛋白酶抑制剂C（eGFRcys）和肌酐半胱氨酸蛋白酶抑制剂C计算eGFR。使用Cox模型比较每种eGFR与CVD预后和死亡率的相关性，并调整动脉粥样硬化危险因素（根据相关风险评分），然后根据C统计量和分类净重分类指数确定预测效用。他们表明，eGFRcys和CVD、死亡率和蛋白尿症最密切相关，增加了对当前CVD风险评分的预测分歧，而传统的基于肌酐的测量与风险之间的关联较弱。临床医生应考虑测量eGFRcy作为心血管风险评估的一部分。

据介绍，慢性肾脏病在普通人群中很常见，并且与过度CVD相关，但是在当前的CVD风险预测模型中，肾脏功能并不重要。

附：英文原文

Title: Glomerular filtration rate by differing measures, albuminuria and prediction of cardiovascular disease, mortality and end-stage kidney disease

Author: Jennifer S. Lees, Claire E. Welsh, Carlos A. Celis-Morales, Daniel Mackay, James Lewsey, Stuart R. Gray, Donald M. Lyall, John G. Cleland, Jason M. R. Gill, Pardeep S. Jhund, Jill Pell, Naveed Sattar, Paul Welsh, Patrick B. Mark

Issue&Volume: 2019-11-07

Abstract: Chronic kidney disease is common in the general population and associated with excess cardiovascular disease (CVD), but kidney function does not feature in current CVD risk-prediction models. We tested three formulae for estimated glomerular filtration rate (eGFR) to determine which was the most clinically informative for predicting CVD and mortality. Using data from 440,526 participants from UK Biobank, eGFR was calculated using serum creatinine, cystatin C (eGFRcys) and creatinine-cystatin C. Associations of each eGFR with CVD outcome and mortality were compared using Cox models and adjusting for atherosclerotic risk factors (per relevant risk scores), and the predictive utility was determined by the C-statistic and categorical net reclassification index. We show that eGFRcys is most strongly associated with CVD and mortality, and, along with albuminuria, adds predictive discrimination to current CVD risk scores, whilst traditional creatinine-based measures are weakly associated with risk. Clinicians should consider measuring eGFRcys as part of cardiovascular risk assessment. Analysis of data from over 400,000 UK Biobank participants shows that eGFR measured by cystatin C, but not serum creatinine, is strongly associated with cardiovascular disease outcomes and mortality.

DOI: 10.1038/s41591-019-0627-8

Source:https://www.nature.com/articles/s41591-019-0627-8

Nature Medicine：《自然—医学》，创刊于1995年。隶属于施普林格·自然出版集团，最新IF：87.241
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