肌酐在腎小球濾過功能損傷診斷中的價值的系統評價_《中國循證醫學雜志》

作者：

李萍 , 趙瑩 , 余霆

四川大學華西醫院實驗醫學科,成都,610041;

關鍵詞：

腎小球濾過功能損傷 Meta分析綜合受試者工作曲線實驗室診斷

視頻：

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　系統評價反映腎小球濾過功能損傷的血清生化標志物肌酐(creatinine, Cr)的診斷效能.
方法　計算機檢索1993～2003年MEDLINE、EMBASE和中國生物醫學文獻數據庫(CBM),按照文內所述的納入標準共收集到關于腎小球濾過功能損傷的實驗室研究指標的文獻34篇,利用SPSS、EXCEL統計軟件以及Cochrane方法學協作組提供的RevMan軟件進行統計分析.
結果　肌酐的綜合比數比(OR)為24.23,綜合受試者工作曲線下面積為0.871.根據不同診斷標準方法(菊粉、鉻-乙二胺四乙酸、锝-二乙烯三乙胺五乙酸、碘海醇和125I-碘他拉酸鹽等)進行分組分析,結果顯示組間分析無顯著性差異(P＝0.32);組內分析菊粉、鉻-乙二胺四乙酸、锝-二乙烯三乙胺五乙酸、碘海醇無顯著差異(P值分別為0.61,0.50,0.36,0.32),125I-碘他拉酸鹽有顯著性差異(P＝0.02);在肌酐不同測定方法診斷效能亞組分析中,苦味酸法有顯著性差異(P＝0.03),酶法組內分析無顯著性差異(P＝0.22).
結論　肌酐對腎小球濾過功能損傷的診斷效能不高,建議仍采用酶法測定肌酐,在肌酐研究中宜選擇菊粉或99mTc-DTPA為其診斷參考標準,并采用前瞻性隊列設計.

引用本文： 李萍,趙瑩,余霆. 肌酐在腎小球濾過功能損傷診斷中的價值的系統評價. 中國循證醫學雜志, 2004, 04(11): 752-758. doi: 復制

1.	［1］Joronen I,Hopsu-Havu VK,M,Rinne A,Jarvinen M,Halonen P.detection of low molecular weight cysteine proteinase inhibitors by time-resolved fluoroimmunoassay[J]. J Immunal Meth, 1986; 86(23): 243-247.
2.	［2］Colle A,Tavera C,Prevot D,Leung-Tack J,Thomas Y,Manuel Y. Cystatin C levels in sera of patein with human immunodeficiency virus infection[J]. J immunoassay, 1992; 13: 47-60.
3.	［3］Wyss M, Kaddurah-Daouk R. Creatine and creatinine metabolism[J]. Physiol Rev. 2000; 80(3): 1 107-1 213.
4.	［4］Qi HM,Xing Gang,Li JZ,Deng LR,Zhang CL,Wang HY.Evaluation of four methods about glomerular filtration function[J]. Laboratory Journal of Chinses Medicine, 2002; 25(3):150152齊慧敏,幸崗,李驚子,鄧利榮,張春麗,王洪源.四種腎小球濾過功能測定方法的評估分析[J]. 中華檢驗醫學雜志,2002;25(3):150～152.
5.	［5］Harmoinen A,Lehtimaki T,Korpela M,Turjanmaa V,Saha H.Diagnostic Accuracies of Plasma creatinine,Cystatin C,and Glomerular flitration rate Calcuated by the Cockcroft-Gault and Levey(MDRD) formulas[J]. Clin Chem, 2003; 49(7): 1 223-1 225.
6.	［6］Christensson A, Ekberg J, Grubb A, Ekberg H, Lindstrom V. Serum cystatin C is a more sensitive and more accurate marker of glomerular filtration rate than enzymatic measurements of creatinine in renal transplantation[J]. Nephron Physiol, 2003; 94(2): 19-27.
7.	［7］Le Bricon T, Thervet E, Froissart M, Benlakehal M, Bousquet B, Legendre C, Erlich D.Clin Chem. Plasma cystatin C is superior to 24h creatinine clearance and plasma creatinine for estimation of glomerular filtration rate 3 months after kidney[J].Transplantation, 2000; 46(8): 1 206-1 207.
8.	［8］Burkhardt H, Bojarsky G, Gladisch R. Diagnostic efficiency of cystatin C and serum creatinine as markers of reduced glomerular filtration rate in the elderly[J]. Clin Chem Lab Med, 2002; 40(11): 1 135-1 138.
9.	［9］Perlemoine C, Beauvieux MC, Rigalleau V, Baillet L, Barthes N, Derache P, Gin H. Interest of cystatin C in screening diabetic patients for early impairment of renal function[J]. Metabolism, 2003; 52(10): 1 258-1 264.
10.	［10］F Chantrel,A grin,M offner,C koehl,B Moulin,T hannedouche. Comparison of cystatin C versus creatinine for mild renal failure[J]. Clin Nephron, 2000; 5(235): 374-381.
11.	［11］Coll E, Botey A, Alvarez L, Poch E, Quinto L, Saurina A, Vera M, Piera C,Darnell A. Serum cystatin C as a new marker for noninvasive estimation of glomerularfiltration rate and as a marker for early renal impairment[J]. Am J Kidney Dis, 2000; 36(1): 29-34.
12.	［12］Donadio C, Lucchesi A, Ardini M, Giordani R. Cystatin C, beta 2-microglobulin, and retinol-binding protein as indicators of glomerular filtration rate: comparison with plasma creatinine[J]. J Pharm Biomed Anal, 2001; 24(5): 835-842.
13.	［13］Filler G, Priem F, Lepage N, Sinha P, Vollmer I, Clark H, Keely E, Matzinger M, Akbari A, Althaus H, Jung K. Related Articles, Links Beta-trace protein, cystatin C, beta(2)-microglobulin, and creatinine compared for detecting impaired glomerular filtration rates in children[J]. Clin Chem, 2002; 48(5): 729-736.
14.	［14］Harmoinen AP, Kouri TT, Wirta OR, Lehtimaki TJ, Rantalaiho V, Turjanmaa VM,Pasternack AI. Evaluation of plasma cystatin C as a marker for glomerular filtration rate in patients with type 2 diabetes[J]. Clin Nephrol, 1999; 52(6): 363-370.
15.	［15］Helin I, Axenram M, Grubb A. Serum cystatin C as a determinant of glomerular filtration rate in children[J]. Clin Nephrol, 1998; 49(4): 221-225.
16.	［16］Kyhse-Andersen J, Schmidt C, Nordin G, Andersson B, Nilsson-Ehle P,Lindstrom V, Grubb A.Serum cystatin C, determined by a rapid, automated particle-enhanced turbidimetric method, is a better marker than serum creatinine for glomerular filtration rate[J]. Clin Chem, 1994; 40(10): 1 921-1 926.
17.	［17］Jung K, Jung M. Cystatin C: a promising marker of glomerular filtration rate to replace creatinine[J]. Nephron, 1995; 70(3): 370-371.
18.	［18］Kazama JJ, Kutsuwada K, Ataka K, Maruyama H, Gejyo F. Serum cystatin C reliably detects renal dysfunction in patients with various renal diseases[J]. Nephron, 2002; 91(1): 13-20.
19.	［19］Pergande M, Jung K. Sandwich enzyme immunoassay of cystatin C in serum with commercially available antibodies[J]. Clin Chem, 1993; 39(9): 1 885-1 890.
20.	［20］Newman DJ, Thakkar H, Edwards RG, Wilkie M, White T, Grubb AO, Price CP. Serum cystatin C measured by automated immunoassay: a more sensitive marker of changes in GFR than serum creatinine[J]. Kidney Int, 1995; 47(1): 312-318.
21.	［21］Oddoze C, Morange S, Portugal H, Berland Y, Dussol B. Cystatin C is not more sensitive than creatinine for detecting early renalimpairment in patients with diabetes[J]. Am J Kidney Dis, 2001; 38(2): 310-316.
22.	［22］Orlando R, Mussap M, Plebani M, Piccoli P, De Martin S, Floreani M, Padrini R, Palatini P. Related Articles, Links Diagnostic value of plasma cystatin C as a glomerular filtration marker in decompensated liver cirrhosis[J]. Clin Chem, 2002; 48(6): 850-858.
23.	［23］Randers E, Erlandsen EJ, Pedersen OL, Hasling C, Danielsen H. Serum cystatin C as an endogenous parameter of the renal function in patients with normal to moderately impaired kidney function[J]. Clin Nephrol, 2000; 54(3): 203-209.
24.	［24］Randers E, Kristensen JH, Erlandsen EJ, Danielsen H. Serum cystatin C as a marker of the renal function[J]. Scand J Clin Lab Invest, 1998; 58(7): 585-592.
25.	［25］Risch L, Blumberg A, Huber A. Rapid and accurate assessment of glomerular filtration rate in patients with renal transplants using serum cystatin C[J]. Nephrol Dial Transplant, 1999; 14(8): 1 991-1 996.
26.	［26］O’Riordan Shelagh E,Webb Michelle C,Stowe Helen J,Simpson David E,Kandarpa Madhu.Cystatin C improves the detection of mild renal dysfunction in older parients[J]. Ann clin biochem, 2003; 40(23): 648-655.
27.	［27］Stickle D, Cole B, Hock K, Hruska KA, Scott MG. Correlation of plasma concentrations of cystatin C and creatinine to inulin clearance in a pediatric population[J]. Clin Chem, 1998; 44(6): 1 334-1 338.
28.	［28］Tan GD, Lewis AV, James TJ, Altmann P, Taylor RP, Levy JC. Related Articles, Links Clinical usefulness of cystatin C for the estimation of glomerular filtration rate in type 1 diabetes: reproducibility and accuracy compared with standard measures and iohexol clearance[J]. Diabetes Care, 2002; 25(11): 2 004-2 009.
29.	［29］Van Den Noortgate NJ, Janssens WH, Delanghe JR, Afschrift MB, Lameire NH. Related Articles, Links Serum cystatin C concentration compared with other markers of glomerular filtration rate in the old old[J]. J Am Geriatr Soc, 2002; 50(7): 1 278-1 282.
30.	［30］Willems HL, Hilbrands LB, van de Calseyde JF, MonnensLA, Swinkels DW. Is serum cystatin C the marker of choice to predict glomerular filtration rate in paediatric patients[J]? Ann Clin Biochem, 2003; 40(1): 60-64.
31.	［31］Woitas RP, Stoffel-Wagner B, Poege U, Schieldermaier P, Spengler u, Sauerbruch T.lower-molecular weight proteins as markers for glomerular filtration rate[J]. Clin Chem, 2001; 47(724): 2 179-2 180.
32.	［32］Woitas RP, Stoffel-Wagner B, Flommersfeld S, Poege U, Schiedermaier P,Klehr HU, Spengler U, Bidlingmaier F, Sauerbruch T. Correlation of serum concentrations of cystatin C and creatinine to inulin clearance in liver cirrhosis[J]. Clin Chem, 2000; 46(5): 712-715.
33.	［33］Ylinen EA, Ala-Houhala M, Harmoinen AP, Knip M. Cystatin C as a marker for glomerular filtration rate in pediatric patients[J]. Pediatr Nephrol, 1999; 13(6): 506-509.
34.	［34］Couched C, Pozet N, Labeeuw M, Pouteil-Noble C.Screening early renal failure: cut-off values for serum creatinine as an indicator of renal impairment[J]. Kidney Int, 1999; 55(5): 1 878-1 884.
35.	［35］Kingdon EJ, Knight CJ, Dustan K, Irwin AG, Thomas M, Powis SH, Burns A,Hilson AJ, Black CM. Calculated glomerular filtration rate is a useful screening tool to identify scleroderma patients with renal impairment[J]. Rheumatology, 2003; 42(1): 26-33.
36.	［36］Caregaro L, Menon F, Angeli P, Amodio P, Merkel C, Bortoluzzi A, AlberinoF, Gatta A. Limitations of serum creatinine level and creatinine clearance as filtration markers in cirrhosis[J].Arch Intern Med, 1994; 154(2): 201-205.
37.	［37］Tezuka M, Murata Y, Ishida R, Sawada Y, Shibuya H. Tc-99m DTPA renography in patients with collagen disease[J]. Clin Nucl Med, 2001; 26(3): 187-192.
38.	［38］Priem F,Althaus H,Brinbaum M,Sinha P,Conradt HS,Jung K.β-trace protein in serum:a new marker of glomerular filtration rate in the creatinine-blind range[J]. Clin Chem, 1999; 45(21): 467-468.
39.	［39］Liu GJ,Wu TX.Meta analysis of diagnostic test--introduction about summary receiver operator characteristic curve[J]. Chineses Journal of Evidence-Based Medicine, 2003, 3(1): 41-44.
40.	劉關鍵,吳泰相.診斷性試驗的Meta分析-SROC曲線法介紹[J]. 中國循證醫學雜志,2003, 3(1): 41～44.
41.	［40］Moses LE, Shapiro D, Littenberg B, combining independent studies of a diagnostic test into a summary ROC curve:data analytic and some additional considerations[J]. Stat Med, 1993, 12: 1 293-1 316.
42.	［41］Wang JL .Clinical Epidemiology[M]. Shanghai scientific and technique Publisher. 2th, 2001, p323-325.
43.	王家良主編.臨床流行病學[M].第2版. 上海: 上海科學技術出版社; 2001. p.323～325.
44.	［42］Kang GF.Clinical biochemistry and biochemical laboratory[M]. people’s health publisher.2th.1998,p272-273.
45.	康格非主編.臨床生物化學和生物化學檢驗[M].第2版. 北京: 人民衛生出版社; 1998. p.272～273.

1. ［1］Joronen I,Hopsu-Havu VK,M,Rinne A,Jarvinen M,Halonen P.detection of low molecular weight cysteine proteinase inhibitors by time-resolved fluoroimmunoassay[J]. J Immunal Meth, 1986; 86(23): 243-247.
2. ［2］Colle A,Tavera C,Prevot D,Leung-Tack J,Thomas Y,Manuel Y. Cystatin C levels in sera of patein with human immunodeficiency virus infection[J]. J immunoassay, 1992; 13: 47-60.
3. ［3］Wyss M, Kaddurah-Daouk R. Creatine and creatinine metabolism[J]. Physiol Rev. 2000; 80(3): 1 107-1 213.
4. ［4］Qi HM,Xing Gang,Li JZ,Deng LR,Zhang CL,Wang HY.Evaluation of four methods about glomerular filtration function[J]. Laboratory Journal of Chinses Medicine, 2002; 25(3):150152齊慧敏,幸崗,李驚子,鄧利榮,張春麗,王洪源.四種腎小球濾過功能測定方法的評估分析[J]. 中華檢驗醫學雜志,2002;25(3):150～152.
5. ［5］Harmoinen A,Lehtimaki T,Korpela M,Turjanmaa V,Saha H.Diagnostic Accuracies of Plasma creatinine,Cystatin C,and Glomerular flitration rate Calcuated by the Cockcroft-Gault and Levey(MDRD) formulas[J]. Clin Chem, 2003; 49(7): 1 223-1 225.
6. ［6］Christensson A, Ekberg J, Grubb A, Ekberg H, Lindstrom V. Serum cystatin C is a more sensitive and more accurate marker of glomerular filtration rate than enzymatic measurements of creatinine in renal transplantation[J]. Nephron Physiol, 2003; 94(2): 19-27.
7. ［7］Le Bricon T, Thervet E, Froissart M, Benlakehal M, Bousquet B, Legendre C, Erlich D.Clin Chem. Plasma cystatin C is superior to 24h creatinine clearance and plasma creatinine for estimation of glomerular filtration rate 3 months after kidney[J].Transplantation, 2000; 46(8): 1 206-1 207.
8. ［8］Burkhardt H, Bojarsky G, Gladisch R. Diagnostic efficiency of cystatin C and serum creatinine as markers of reduced glomerular filtration rate in the elderly[J]. Clin Chem Lab Med, 2002; 40(11): 1 135-1 138.
9. ［9］Perlemoine C, Beauvieux MC, Rigalleau V, Baillet L, Barthes N, Derache P, Gin H. Interest of cystatin C in screening diabetic patients for early impairment of renal function[J]. Metabolism, 2003; 52(10): 1 258-1 264.
10. ［10］F Chantrel,A grin,M offner,C koehl,B Moulin,T hannedouche. Comparison of cystatin C versus creatinine for mild renal failure[J]. Clin Nephron, 2000; 5(235): 374-381.
11. ［11］Coll E, Botey A, Alvarez L, Poch E, Quinto L, Saurina A, Vera M, Piera C,Darnell A. Serum cystatin C as a new marker for noninvasive estimation of glomerularfiltration rate and as a marker for early renal impairment[J]. Am J Kidney Dis, 2000; 36(1): 29-34.
12. ［12］Donadio C, Lucchesi A, Ardini M, Giordani R. Cystatin C, beta 2-microglobulin, and retinol-binding protein as indicators of glomerular filtration rate: comparison with plasma creatinine[J]. J Pharm Biomed Anal, 2001; 24(5): 835-842.
13. ［13］Filler G, Priem F, Lepage N, Sinha P, Vollmer I, Clark H, Keely E, Matzinger M, Akbari A, Althaus H, Jung K. Related Articles, Links Beta-trace protein, cystatin C, beta(2)-microglobulin, and creatinine compared for detecting impaired glomerular filtration rates in children[J]. Clin Chem, 2002; 48(5): 729-736.
14. ［14］Harmoinen AP, Kouri TT, Wirta OR, Lehtimaki TJ, Rantalaiho V, Turjanmaa VM,Pasternack AI. Evaluation of plasma cystatin C as a marker for glomerular filtration rate in patients with type 2 diabetes[J]. Clin Nephrol, 1999; 52(6): 363-370.
15. ［15］Helin I, Axenram M, Grubb A. Serum cystatin C as a determinant of glomerular filtration rate in children[J]. Clin Nephrol, 1998; 49(4): 221-225.
16. ［16］Kyhse-Andersen J, Schmidt C, Nordin G, Andersson B, Nilsson-Ehle P,Lindstrom V, Grubb A.Serum cystatin C, determined by a rapid, automated particle-enhanced turbidimetric method, is a better marker than serum creatinine for glomerular filtration rate[J]. Clin Chem, 1994; 40(10): 1 921-1 926.
17. ［17］Jung K, Jung M. Cystatin C: a promising marker of glomerular filtration rate to replace creatinine[J]. Nephron, 1995; 70(3): 370-371.
18. ［18］Kazama JJ, Kutsuwada K, Ataka K, Maruyama H, Gejyo F. Serum cystatin C reliably detects renal dysfunction in patients with various renal diseases[J]. Nephron, 2002; 91(1): 13-20.
19. ［19］Pergande M, Jung K. Sandwich enzyme immunoassay of cystatin C in serum with commercially available antibodies[J]. Clin Chem, 1993; 39(9): 1 885-1 890.
20. ［20］Newman DJ, Thakkar H, Edwards RG, Wilkie M, White T, Grubb AO, Price CP. Serum cystatin C measured by automated immunoassay: a more sensitive marker of changes in GFR than serum creatinine[J]. Kidney Int, 1995; 47(1): 312-318.
21. ［21］Oddoze C, Morange S, Portugal H, Berland Y, Dussol B. Cystatin C is not more sensitive than creatinine for detecting early renalimpairment in patients with diabetes[J]. Am J Kidney Dis, 2001; 38(2): 310-316.
22. ［22］Orlando R, Mussap M, Plebani M, Piccoli P, De Martin S, Floreani M, Padrini R, Palatini P. Related Articles, Links Diagnostic value of plasma cystatin C as a glomerular filtration marker in decompensated liver cirrhosis[J]. Clin Chem, 2002; 48(6): 850-858.
23. ［23］Randers E, Erlandsen EJ, Pedersen OL, Hasling C, Danielsen H. Serum cystatin C as an endogenous parameter of the renal function in patients with normal to moderately impaired kidney function[J]. Clin Nephrol, 2000; 54(3): 203-209.
24. ［24］Randers E, Kristensen JH, Erlandsen EJ, Danielsen H. Serum cystatin C as a marker of the renal function[J]. Scand J Clin Lab Invest, 1998; 58(7): 585-592.
25. ［25］Risch L, Blumberg A, Huber A. Rapid and accurate assessment of glomerular filtration rate in patients with renal transplants using serum cystatin C[J]. Nephrol Dial Transplant, 1999; 14(8): 1 991-1 996.
26. ［26］O’Riordan Shelagh E,Webb Michelle C,Stowe Helen J,Simpson David E,Kandarpa Madhu.Cystatin C improves the detection of mild renal dysfunction in older parients[J]. Ann clin biochem, 2003; 40(23): 648-655.
27. ［27］Stickle D, Cole B, Hock K, Hruska KA, Scott MG. Correlation of plasma concentrations of cystatin C and creatinine to inulin clearance in a pediatric population[J]. Clin Chem, 1998; 44(6): 1 334-1 338.
28. ［28］Tan GD, Lewis AV, James TJ, Altmann P, Taylor RP, Levy JC. Related Articles, Links Clinical usefulness of cystatin C for the estimation of glomerular filtration rate in type 1 diabetes: reproducibility and accuracy compared with standard measures and iohexol clearance[J]. Diabetes Care, 2002; 25(11): 2 004-2 009.
29. ［29］Van Den Noortgate NJ, Janssens WH, Delanghe JR, Afschrift MB, Lameire NH. Related Articles, Links Serum cystatin C concentration compared with other markers of glomerular filtration rate in the old old[J]. J Am Geriatr Soc, 2002; 50(7): 1 278-1 282.
30. ［30］Willems HL, Hilbrands LB, van de Calseyde JF, MonnensLA, Swinkels DW. Is serum cystatin C the marker of choice to predict glomerular filtration rate in paediatric patients[J]? Ann Clin Biochem, 2003; 40(1): 60-64.
31. ［31］Woitas RP, Stoffel-Wagner B, Poege U, Schieldermaier P, Spengler u, Sauerbruch T.lower-molecular weight proteins as markers for glomerular filtration rate[J]. Clin Chem, 2001; 47(724): 2 179-2 180.
32. ［32］Woitas RP, Stoffel-Wagner B, Flommersfeld S, Poege U, Schiedermaier P,Klehr HU, Spengler U, Bidlingmaier F, Sauerbruch T. Correlation of serum concentrations of cystatin C and creatinine to inulin clearance in liver cirrhosis[J]. Clin Chem, 2000; 46(5): 712-715.
33. ［33］Ylinen EA, Ala-Houhala M, Harmoinen AP, Knip M. Cystatin C as a marker for glomerular filtration rate in pediatric patients[J]. Pediatr Nephrol, 1999; 13(6): 506-509.
34. ［34］Couched C, Pozet N, Labeeuw M, Pouteil-Noble C.Screening early renal failure: cut-off values for serum creatinine as an indicator of renal impairment[J]. Kidney Int, 1999; 55(5): 1 878-1 884.
35. ［35］Kingdon EJ, Knight CJ, Dustan K, Irwin AG, Thomas M, Powis SH, Burns A,Hilson AJ, Black CM. Calculated glomerular filtration rate is a useful screening tool to identify scleroderma patients with renal impairment[J]. Rheumatology, 2003; 42(1): 26-33.
36. ［36］Caregaro L, Menon F, Angeli P, Amodio P, Merkel C, Bortoluzzi A, AlberinoF, Gatta A. Limitations of serum creatinine level and creatinine clearance as filtration markers in cirrhosis[J].Arch Intern Med, 1994; 154(2): 201-205.
37. ［37］Tezuka M, Murata Y, Ishida R, Sawada Y, Shibuya H. Tc-99m DTPA renography in patients with collagen disease[J]. Clin Nucl Med, 2001; 26(3): 187-192.
38. ［38］Priem F,Althaus H,Brinbaum M,Sinha P,Conradt HS,Jung K.β-trace protein in serum:a new marker of glomerular filtration rate in the creatinine-blind range[J]. Clin Chem, 1999; 45(21): 467-468.
39. ［39］Liu GJ,Wu TX.Meta analysis of diagnostic test--introduction about summary receiver operator characteristic curve[J]. Chineses Journal of Evidence-Based Medicine, 2003, 3(1): 41-44.
40. 劉關鍵,吳泰相.診斷性試驗的Meta分析-SROC曲線法介紹[J]. 中國循證醫學雜志,2003, 3(1): 41～44.
41. ［40］Moses LE, Shapiro D, Littenberg B, combining independent studies of a diagnostic test into a summary ROC curve:data analytic and some additional considerations[J]. Stat Med, 1993, 12: 1 293-1 316.
42. ［41］Wang JL .Clinical Epidemiology[M]. Shanghai scientific and technique Publisher. 2th, 2001, p323-325.
43. 王家良主編.臨床流行病學[M].第2版. 上海: 上海科學技術出版社; 2001. p.323～325.
44. ［42］Kang GF.Clinical biochemistry and biochemical laboratory[M]. people’s health publisher.2th.1998,p272-273.
45. 康格非主編.臨床生物化學和生物化學檢驗[M].第2版. 北京: 人民衛生出版社; 1998. p.272～273.

《中國循證醫學雜志》

肌酐在腎小球濾過功能損傷診斷中的價值的系統評價

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《中國循證醫學雜志》

肌酐在腎小球濾過功能損傷診斷中的價值的系統評價

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