探讨血清半胱氨酸蛋白酶抑制剂C在糖尿病肾病早期肾损伤中的诊断价值

To investigate the diagnostic value of cystatin C mensuration in early renal impairment on diabetic nephropathy

目的探讨血清半胱氨酸蛋白酶抑制剂C(cystatin C,CysC)对糖尿病肾病(diabetic nephropathy,DN)早期诊断的价值.方法应用乳胶颗粒增强散射免疫比浊法测定108例糖尿病(diabetes mellitus,DM)患者和30名健康体检者的血清CysC浓度,并同时测定血清肌酐(serum creatinine,SCr)、β_(2)-微球蛋白(β_(2)-microglobulin,β_(2)-MG)、糖化血红蛋白(HbAlc)和尿微量白蛋白(urine microalbuminuria,UMA)并计算肌酐清除率(creatinine clearance rate,CCr),然后分析CysC与其他指标的相关性并绘制各指标的受试者工作特征(receiver operating characteristic,ROC)曲线.结果DM各组及对照组间性别、年龄差异均无统计学意义(P均>0.05),但空腹血糖、HbAlc差异均有统计学意义(P均<0.01).与对照组比较,A组仅有CysC检测水平差异有统计学意义(P<0.05),其余指标差异均无统计学意义(P均>0.05);而B、C组各指标检测水平与对照组比较,差异均有统计学意义(P均<0.01).A组与B、C组比较除CCr检测水平差异无统计学意义外(P>0.05),其余各指标检测水平差异均有统计学意义(P均<0.05).B组与C组比较,CysC,β_(2)-MG检测水平差异无统计学意义(P均>0.05),其余指标检测水平差异均有统计学意义(P均<0.05);DM患者血清CysC与SCr、β_(2)-MG、UMA均呈正相关,与CCr呈负相关,相关系数分别为0.601、0.922、0.521、-0.603(P均<0.01);血清CysC、SCr、CCr、β_(2)-MG和UMA的曲线下面积分别为0.901、0.680、0.750、0.780、0.808.结论CysC对DN的诊断价值较其他指标更好.

Objective To evaluate the diagnostic value of cystatin C(CysC)in early renal impairment on diabetic nephropathy(DN).Methods The levels of serum CysC in 108 cases of diabetes mellitus(DM)and 30 healthy controls were determined by particle enhanced nephelometric immunoassay.At the same time,serum creatinine(SCr),β_(2)-microglobulin(β_(2)-MG),urine microalbuminuria(UMA)and HbAlc were measured in all subjects.The creatinine clearance rate(CCr)was calculated.The correlation of CysC with other indicators were analyzed and the receiver operating characteristic(ROC)curve of indicaters were drew.Results There were no statistical significance in the differences of gender and age among DM groups and control group(Pall>0.05).There were statistical significance in the differences of HbA lc and fasting blood glucose(Pall<0.01).There were no statistical significance in the differences of all indexes except CysC between A group and control group(Pall>0.05).There were statistical significance in the differences of all indexes between B,C group and control group(Pall<0.01).There were statistical significance in the differences of all indexes except CCr between A group and B,C group(Pall<0.05).There were statistical significance in the differences of all indexes except CysC and β_(2)-MG between B group and C group(Pall<0.05).CysC and SCr,β_(2)-MG,UMA was positive correlated,CysC and CCr was negative correlated,and the correlation coefficient were 0.601,0.922,0.521,-0.603 respectively(Pall<0.01);The area under curve of CysC,SCr,CGr,β_(2)-MG and UMA were 0.901,0.680,0.750,0.780 and 0.808.Conclusion The value of CysC for the diagnosis of DN is best among indicators.