胱抑素C和尿蛋白联合分析对早期糖尿病肾病的诊断价值研究

Study on the Diagnostic Value of Combinative Measuring of Serum Cystatin C and Urinary Proteins in Patients with Early Diabetic Nephropathy

目的探讨糖尿病患者血清胱抑素C(CysC)、尿白蛋白(Alb)、β2微球蛋白(β2-M)、Tamm-Horsfall蛋白(T-HP)及视黄醇结合蛋白(RBP)的变化对早期糖尿病肾病的诊断价值。方法分别采用免疫比浊法和放射免疫法对糖尿病病人和正常人血清中的Cysc含量及尿中4项尿蛋白指标(Alb、β2-M、T-HP和RBP)的水平进行联合检测。结果糖尿病患者尿Alb、β2-M、RBP及血清CysC显著高于正常人(P<0.01),而尿T-HP则明显低于正常人(P<0.01),尿RBP水平与尿Alb含量呈显著正相关(r=+0.47,P<0.05)。随着肾脏病变的加重上述各项指标的异常改变更趋显著。结论联合检测糖尿病病人尿Alb、β2-M、T-HP、RBP及血清CysC有助于糖尿病肾病的早期诊断。

Objective To explore the clinical diagnostic value of combinative measuring of serum cystatin C （CysC） and urinary proteins including albumin （Alb）, β2-microglobulin （ β2-M ）, Tamm-Horsfall protein （T-HP） and retinol-binding protein （RBP） for early diabetic nephropathy in patients with diabetes mellitus （DM）. Method The levels of serum CysC and the amounts of 24 h urinary excretion of Alb, β2-M,T-HP and RBP in 103 patients with DM and 40 healthy control subjects were determined by immunonephelometry, radioimmunoassay and enzyme immunoassay, respectively. Result The levels of serum CysC and the amounts of 24 h urinary excretion of Alb, β2- M and RBP in patients with DM were significantly higher than those in healthy control subjects（P〈0.01）, while the amount of T-HP was significantly lower （P〈0.05）. The amount of 24 h urinary excretion of RBP was positively correlated with that of 24 h urinary excretion of Alb in patients with DM. Among the diabetic patients, the changes of the levels of serum CysC and the amounts of urinary proteins excretion were more pronounced in those with advanced impairment of renal function. Conclusion Combined determination of serum CysC and urinary proteins was hepful for diagnosis and assessment of eary diabetic nephropathy.