血清同型半胱氨酸、胱抑素C及尿微量白蛋白联合检测在糖尿病早期肾病中的意义

Clinical Significance of Joint Detection of Serum Homocysteine,Cystatin C and Microalbuminuria in Early Diabetic Nephropathy

目的探讨血清同型半胱氨酸(homocysteine,HCY)、胱抑素C(Cystatin C,CysC)及尿微量白蛋白(microalbuminuria,mAlb)联合检测在糖尿病患者(Diabetes,DM)中早期肾损害的诊断价值。方法研究101例DM及30例糖尿病肾病患者和36例健康对照的HCY、CysC及尿mAlb变化,以及三指标的联合检测。采用循环酶法测定HCY,两点终点法测定CysC,免疫比浊法测定尿mAlb。同时检测受检者的尿素氮(BUN)、肌酐(Cr)水平。结果DM患者的HCY、CysC及尿mAlb较正常对照升高(P<0.05),而DN患者升高的更为显著(与DM组尿常规蛋白阳性组比较P<0.05)。DM患者蛋白阳性组较蛋白阴性组HCY、CysC及尿mAlb升高更明显(P<0.05),且三项联合检测阳性率达88.12%,明显高于单项检测(P<0.05)。结论血清HCY、胱抑素C及尿mAlb随糖尿病肾病的发生以及严重程度逐渐增高,可作为早期诊断糖尿病肾病较敏感的指标;联合检测能大大提高检测阳性率,对于监测早期糖尿病肾病的发生和病情发展程度有重要意义。

Objective To study the diagnostic value of the joint detection of serum homocysteine, Cystatin C and micrealbuminuria in early diabetic nephropathy. Methods The difference of HCY, CysC, and mAIb among population included 101 patients with diabetes mellitus （DM）, 30 patients with diabetic nephropathy （DN）, and 36 healthy controls was studied, meanwhile, the rate of combined detection was analyzed. Homocysteine was conducted by enzymatic cycle, Cystatin C was determined by two - point end assay, and microalbuminuria was detected by immunoturbidimetric assay. BUN and Or were determined in all subjects at the same time. Results As compared with normal controls, the levels of serum homo- cysteine, Cystatin C and micrcalbuminuria in DM patients increased （P 〈 0.05）, while the levels of serum homocysteine, Cystatin C and microalbuminuria elevated more significantly in DN patients than in patients with DM whose urinary protein was positive （P〈0.05）. And the levels of serum homocysteine, Cystatin C and microalbuminuria in patients with DM whose urinary protein was positive increased more significantly than in patients with DM whose urinary protein was negative （P 〈 0.05）. Moreover, the positive rate of combined detection reached 88.12%, which was significantly higher than that of the individual testing （P〈0.05）. Conclusions With the occurrence of diabetic nephropathy, as well as an increasing severity, the levels of serum homocysteine, Cystatin C and microalbuminuria gradually increase, thus they can diagnose early diabetic nephropathy as sensitive indicators. And combined detection can greatly increase the positive rate, which is important in monitoring the occurrence of early diabetic nephropathy and the degree of progression of the disease.