胱抑素C与尿微量蛋白及尿酶联合检测在不同程度肾病中的应用价值

Application of Serum Cystatin C,Urinary Microprotein and Urinary Enzyme in the Degree of Nephropathy

目的探讨血清胱抑素C(cystatinC,CysC)、尿微量蛋白与尿酶联合检测对不同程度肾脏损害的临床诊断价值、可行性和监控作用。方法血清胱抑素C采用颗粒增强透射免疫比浊法(PETIA)分析,对30名健康对照者和98名不同病程的肾功能损害者进行尿微量清蛋白(mAlb)、尿转铁蛋白(UTf)、α1-微球蛋白(α1-MG)、β2-微球蛋白(β2-MG)进行检测分析,动态监测法测N-乙酰-β-D-氨基葡萄糖苷酶(NAG),Jaffe速率法测肌酐。结果血清胱抑素C、尿微量蛋白与NAG/Cr测定结果明显高于健康对照组,其差异有统计学意义(P<0.01)。但肌酐清除率(Ccr)、血尿素(BuN)、血肌酐(Cr)在早期临床无症状组的比较中,无统计学意义(P>0.05),单项检测时阳性率较低,联合检测时阳性率可明显提高,可达91.83;血清胱抑素C、尿微量蛋白与尿酶和肾病的严重程度呈显著正相关。结论尿蛋白定性阴性不能排除肾脏的早期损伤,血清胱抑素C、尿微量蛋白与尿酶联合检测是诊断肾脏早期损伤的灵敏与可靠的实验室指标,它在肾脏损伤程度的分析中有重要的意义。

Objective To study the clinical value and the feasibility of serum cystatin C（Cys C）,urinary microprotein and urinary enzyme in diagnosis and monitoring in the degree of kidney damaged. Methods Serum Cys C was determined by partical-enhanced turbidimetric immunoassay（PETIA）. 30 cases health control and 98 cases of nephropathies patients in different progress of the disease were selected, urinary microalbumin （mAlb）, urinary transferring （UTf）, α1-microglobulin （α1-MG） and β2-microglobulin （β2-MG） were measured with immunoturbidimetry, N-acetyl-D-glucosaminidase （NAG） were measured with continuous monitoring assay,urinary creatinine was determined with Jaffe rate. Results The levels of Cys C,urinary mAIb,UTf,α1-MG, βz-MG and NAG/Cr in the group of early nephropathy without clinical symptom were higher than health control group,and the differences had statistic significance （P〈0. 01）. The levels of Cer were higher than health control group, but no statistical significance（P〉0. 05）. Positive rate of determining one of the several items were lower than that（91.83%） of determining the several items together. There was a positive correlation between serum Cys C,urinary mAIb,NAG/Cr and the degree of nephropathy. Conclusion The negative result of qualitative urine protein can not exclude early damaged of nephropathy. It is more sensitive and reliable to union detection of serum Cys C ,urine microprotein and urine enzyme for early discovery and diagnosis nephropathy. It is great importance for analysis the degree of nephropathy.