血清Cys C、尿NAG检测在2型糖尿病早期肾功能损害的临床意义

Application of serum Cys C,NAG in clinical significance of early diabetic nephropathy

目的探讨血清半胱氨酸酶抑制剂C(cystatin C,Cys C)、尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)在糖尿病患者不同肾功能损害中的临床意义。方法运用回顾性分析方法,选择113例在我院住院的2型糖尿病患者,根据24 h尿白蛋白排泄率(UAER),分为正常蛋白尿组、微量蛋白尿组和临床蛋白尿组,检测各项生化指标、尿白蛋白排泄率(UAER)、尿NAG、肾小球滤过率(GFR)。结果 (1)随着病情的加重,血清Cys C、尿NAG水平逐渐升高,微量蛋白尿组和临床蛋白尿组患者的Cys C水平、尿NAG与正常蛋白尿组比较差异均有统计学意义;临床蛋白尿组的Cys C水平、尿NAG与微量蛋白尿组比较差异有统计学意义。(2)血清Cys C与血肌酐、尿白蛋白排泄率呈正相关(r分别为0.741、0.617,P均<0.01),与GFR呈负相关(r=-0.606,P<0.01);尿NAG与血肌酐、尿白蛋白排泄率呈正相关(r分别为0.558、0.617,P均<0.01),与GFR呈负相关(r=-0.524,P<0.01)。(3)血清Cys C的曲线下面积(AUCROC)为0.916,诊断准确性较高,与白蛋白排泄率的AUCROC相当,但明显优于尿素氮、血肌酐。尿NAG的AUCROC为0.720,诊断准确性中等。结论血清Cys C、尿NAG能够作为检测T2DM患者早期肾功能损害的指标。

Objective To investgate the clinical significance of eystatin C（Cys C）,N-acetyl-D-glucosaminidase（NAG） in the damage degree of diabetic nephropathy.Methods 113 cases with type 2 diabets admitted into the hospital were enrolled into the retrospective study,they are divided into three groups according to UAER levels,including diabetes mellitus without albuminiria,microalbuminiria and macroalbuminiria.Common characters were recorded such as sex,age,smoke status.All subjects were measured Urinary albumin rate,N-acetyl-D-glucosaminidase（NAG）,Glomerular filtration rate（GFR）.Results（1） The level of eystatin C,NAG increase along with the aggravation of the disease;The level of eystatin C,NAG are higer in microalbuminiria goup and macroalbuminiria group than that of diabetes mellitus without albuminiria group;The level of eystatin C,NAG are much higer in macroalbuminiria group than that of microalbuminiria goup;（2） There was a positive correlation with eystatin C and Serum creatinine（Scr）,Urinary albumin rate,Schwartz was 0.741,0.617（P〈0.01）,there was a negative correlation between eystatin C and Glomerular filtration rate（GFR）,and Schwartz was-0.606（P〈0.01）,The correlation between NAG and Serum creatinine（Scr）,Urinary albumin rate,GFR was 0.558,0.617,-0.524（P〈0.01）;（3） The study showed AUCROC of eystatin C is larger than that of Scr,and similar to that of UAER.Conclusion Cystatin C,NAG could be used to as sensitive indicator for diagnose the damage in kidney of diabetes.