C反应蛋白和胱抑素C在评价糖尿病早期肾损害中的应用研究

THE STUDY ON THE VALUE OF SERUM C-REACTIVE PROTEIN AND CYSTATIN C IN DIAGNOSIS OF EARLY RENAL DAMAGE DUE TO DIABETES

目的探讨联合检测血清C反应蛋白（CRP）和胱抑素C（CysC）对糖尿病早期肾损害的诊断价值。方法据24h尿微量白蛋白排出量将88例2型糖尿病患者分为三组,即正常白蛋白尿组（A组,尿白蛋白〈30mg/24h）,微量白蛋白尿组（B组,尿白蛋白30~300mg/24h）,大量白蛋白尿组（C组,尿白蛋白〉300mg/24h）;另选门诊健康体检者20例作为健康对照组（N组）。检测各组血清CysC、CRP、空腹血糖（FBG）、糖化血红蛋白（HbA1c）、血压收缩压（SBP）、舒张压（DBP）、体重指数（BMI）、甘油三酯（TG）、胆固醇（TC）、尿素（BUN）、肌酐（SCr）,并且计算内生肌酐清除率（CCR）。结果与正常蛋白尿组比较,微量和大量白蛋白尿组血Cysc明显升高,差异有统计学意义（P〈0.01或P〈0.05）,大量白蛋白尿组较微量白蛋白尿组Cysc也明显升高（P〈0.05）;三组糖尿病患者血清CRP水平与正常对照组比较,显著升高,差异有统计学意义（P〈0.01）,随着尿蛋白的增多而升高;CysC与CCR呈负相关（r=-0.417,P〈0.05）,与BUN,Cr、CRP呈正相关（r=0.318,0.393,0.405）,均有统计学意义（P〈0.05）。结论 CysC水平可以敏感地反应糖尿病肾脏损害的发生,联合检测CRP与Cysc对糖尿病肾病的早期诊断具有重要的临床意义。

Objective To investigate the value of combined measurement of the early type 2 diabetic nephropathy.Methods Eighty-eight cases with type 2 diabetes were divided into three groups according to urinary protein excretion： the group with normal albuminuria（group A,albuminuria lower than 30mg/24h）,the group with microalbuminuria（group B,albuminuria 30-300mg/24h）and the group with macroalbuminuria（group C,albuminuria higher than 300mg/24h）.20 out-patient health persons were chosen as control group at the same time.The level of serum c-reactive protein,cystatin C,total cholesterol,triglyceride,fasting blood glucose,serum creatinine,blood urea nitrogen,glycosylated hemoglobin,systolic pressureiastolic,pressure body mass index and the amount of urinary albumin excretion in 24 hours were measured in all subjects,and endogenous creatinine clearance rate（CCR） were calculated in every diabetes patients.Results Comparison with groupA,the level of cystatin C was raised markedly in group B and group C,and there was also a significant difference between group B and group C（P0.05）.Compared with the control group,the serum level of CPR was raised markedly in other three groups（P0.01）,its levels was along with the increase of urine protein increases.The level of cystatin C was inverse correlation to CCR（the correlation coefficient was-0.417） and positive correlation to BUN,SCr and CRP（the correlation coefficient were 0.318,0.393,0.405,respectively）（P0.05）.Conclusion Cystatin C can indicate the impairment of early type 2 diabetic nephropathy,The combination of serum CRP and cystatin C have high value for clinical diagnosis of early renal damage due to Diabetes.