胱抑素C和估算的肾小球滤过率在糖尿病肾病早期诊断中的应用

The application of cystatin C and estimated glomerular filtration rate in diagnosis of early diabetic nephropathy

目的:探讨肾小球滤过率评估方程和胱抑素C(CysC)在糖尿病肾病中的应用。方法:测定2型糖尿病患者86例和20例健康体检者尿微量蛋白(MP)、尿微量白蛋白(M-Alb)、尿肌酐,血清肌酐(Scr)、血清胱抑素C;应用简化MDRD方程和Cockcroft-Gault方程(C-G)估算糖尿病患者的肾小球滤过率并与内生肌酐清除率比较。结果:糖尿病各组简化MDRD方程和Cockcroft-Gault方程估算的肾小球滤过率随内生肌酐清除率(Ccr)的降低而降低,Scr、CysC、MP、M-Alb随内生肌酐清除率(Ccr)的降低而升高;在60≤Ccr<90ml/[min·(1.73m2)],Scr、CysC、MP、M-Alb、MDRD-GFR、C-G-GFR的灵敏度分别为7.41%、14.8%、61.5%、55.6%、37.0%、40.7%。结论:CysC在GFR轻度异常时其灵敏度不如尿微量白蛋白、尿微量蛋白、用C-G方程、MDRD方程估算的肾小球滤过率。

Objective： To investigate the application of the Serum cystatin C （CysC） and the formula to evaluate glomerular filtration rate in diabetic nephropathy. Methods： Urine protein （MP）, Urine microalbumin（M-Alb）,urine creatinine,serum creatinine（Scr） and Serum cystatin C levels were determined in 20 controls and 86 patients with type 2 diabetic mellitus, Glomerular filtration rate （GFR） estimated with abbreviated MDRD equation （MDRD-GFR） and Cockcroft-Gault equation （C-G-GFR） were compared with endogenous creatinine clearance （Ccr）. Results：In diabetes mellitus patients, as Ccr decreased gradually,the average levels of MP,M-Alb,Scr and CysC increased,while MDRD-GFR and C-G-GFR deereased. In 60≤Cer 〈90 ml/[min·（1.73m^2）],the sensitivity were 7.41%,14.8%,61.5%,55.6%,37.0% and 40.7% with Scr, CysC, MP, M-Alb, MDRD-GFR and C G-GFR respectively. Conclusion：When GFR is mild abnormal, the CysC is more sensitivity than Scr,is lower sensitivity than MP,M-Alb,MDRD-GFR and C-G-GFR.