糖尿病肾病患者的胱抑素C水平及其临床意义

Clinical Significance of Cystatin C Level in Patients with Diabetic Nephropathy

目的探讨血浆胱抑素C水平变化与糖尿病肾病的相关性。方法 2型糖尿病患者95例按尿蛋白含量分为3组,正常组28例、微量组32例、大量白蛋白尿组35例,同期体检健康者30例为对照组。测定各组血浆CysC、血肌酐、尿肌酐、24 h尿微量白蛋白(mALB),计算内生肌酐清除率(Ccr)。结果 (1)不同性别、年龄、体重指数(BMI)及糖化血红蛋白(HbA1c)的2型糖尿病患者血浆胱抑素C水平比较,差异无统计学意义(P>0.05)。(2)微量、大量白蛋白尿组患者血浆胱抑素C、mALB水平均明显高于正常白蛋白尿组及对照组(P<0.05),大量白蛋白尿组的血肌酐、Ccr明显高于其他3组(P<0.05)。(3)2型糖尿病患者胱抑素C与mALB呈正相关关系(P<0.05),胱抑素C与Ccr的相关性(r=-0.758),优于血肌酐与Ccr的相关性(r=-0.672)。结论胱抑素C能更敏感地发现2型糖尿病患者早期肾功能变化,其可以作为预测糖尿病肾病严重程度的指标之一。

Objective To explore the relationship of cystatin C （ Cys C） level changes with diabetic nephropathy. Methods Ninety-five patients with type 2 diabetes mellitus were divided into three groups according to the albuminuria content,28 cases in the normal albuminuria group ,32 cases in the nficm-albuminuria group,and 35 cases in the ro, acro-albuminuria group. Thirty cases reveiving health examination were enrolled in the control group. Plasma Cys C, serum creatinine （Scr）, urinary creatinine, ？A-hour urine micro-albuminuria （mALB） were detected in each group, and creatinine clearance rate（Ccr） was calculated. Results （1） There was no significant difference in the Cys C level among type 2 diabetes mellitus patients of different age, gender, body mass index （BMI）, or glycosylated hemoglobin （ HbA1 c ） （P 〉0.05）. （2） Plasma Cys C level and mALB level in the micro-albuminuria group and macro-albuminuria group were significantly higher than those in the normal albuminuria group and control group（P 〈0.05） ,and Scr,Ccr in the macro-albuminuria group were significantly higher than those in the other three groups （P 〈 0.05 ）. （3） Cys C was positively correlated with mALB in patients with type 2 diabetes mellitus（ P 〈0.05 ） ,and the correlation of Cys C with Ccr（ r = -0.758） was superior to that of Scr with Ccr（ r = -0.672）. Conclusion Cys C is more sensitive to detect early renal function decline in patients with type 2 diabetes meUitus,which can be used as an index for predicting the severity of diabetic nephropathy.