血清胱抑素C诊断早期糖尿病肾病肾损害

Clinical Evaluation of Serum Cystatin C in Early-stage Diabetic Nephropathy

目的：测定血清胱抑素C（CysC）在早期糖尿病肾病患者中的水平，探讨血清胱抑素C是否是一种反映肾小球滤过率变化的理想的内源性标志物。方法：检测2型糖尿病患者24h尿微量白蛋白（UAE）并选择性分成两组，其中UAE〈30mg·24h^-1为I组（30例），UAE在30～300mg·24h^-1为Ⅱ组（30例），对照组（Ⅲ组）为正常体检者（30例），同时测定血清CysC、血β2微球蛋白（β2-MG）、血肌酐（Cr），3组进行比较。Ⅱ纽给予ACEI＋ARB治疗6个月后复测CysC、血β2-MG、血Cr及UAE，与未治疗前比较。结果：在I组（0．98±0．18mg·L^-1）和Ⅱ组（1．83±0．66mg·L^-1）CysC的浓度均比对照组（0．74±0．11mg·L^-1）显著升高，同时I组和Ⅱ组之间的比较也有（P〈0．001）。I组血β2-MG浓度（2．27±0．74mg·L^-1）与对照组（1．76±0．69mg·L^-1）比较无显著差异（P〉0．2），而Ⅱ组血β2-MG浓度（5．80±1．53mg·L^-1）与对照组和I组之间的比较均有升高（P〈0．001），血Cr的浓度在I组（75．83±16．58μmmol·L^-1）、1I组（97．26±15．26μmmol·L^-1）及对照组（74．26±15．01μmmol·L^-1），3组之间的比较均无显著差异（P〉0．5）。Ⅱ组在用药后的CysC浓度比用药前显著下降（P〈0．05），UAE的浓度也显著下降（P〈0．001），而血β2-MG、血Cr用药前后的比较均无显著变化（P〉0．5）。结论：血清胱抑素C是一种反映早期糖尿病肾病的肾小球滤过率变化的理想的标志物。

Objective：To determine whether cystatin C is an ideal marker to reveal the GFR by testing the level of serum cystatin C in early-stage diabetic nephropathy patients. Methods： Sixty type 2 diabetic patients were enrolled and divided into two group. Group I was given urinary albumin excretions （UAE）〈30mg/24hours（n = 30）, while group 11 was given with UAE30～300mg/24hours（n = 30） and 30 normal persons as the control （group Ⅲ ）. Serum cystatin C,β2-microglobulin（β2- MG） ,creatinine were determined in all groups. ACEI ＋ ARB were used in group II for 6 months, serum cystatin C,β2-MG, creatinine UAE were determined after 6 months,comparisons were made before and after therapy. Results： Serum cystatin C concentrations were significantly higher in group I（0. 98±0. 18mg/1 and groupⅡ（1.83±0.66mg/l） compared to the controls （0.74±0.11mg/1）（P〈0. 001）. There was no significant difference between group I（2.27±0.74mg/1） and controls （1.76±0.69mg/1）in serum β2-MG concentrations（P〉0.2）. However, serum β2-MG concentrations were significantly higher in group II（5.8O±1.53mg/1） compared to controls, and it was the same in group I compared to group II（P〈0. 001）. There were no significant differences in serum creatinine between group I（75.83±16. 58μmmol/1） and controls（74. 26± 15.01μmmol/1）, group II （97.26 ±15.26μmmol/1）and controls, group I and group II（P〉0. 5）. In group II, before and after therapy, there is statistical difference in serum cystatin C concentrations （P〉0. 001）, but no statistical difference was found in serum creatinine, β2-MG（P〉0.5）. Conclusion：Serum cystatin C is ideal marker to reveal the GFR in early-stage diabetic nephropathy patients, Early determination of serum cystatin C may delay [-the progress of diabetic nephropathy.