血清胱抑素C、同型半胱氨酸及尿微量清蛋白/肌酐比值在糖尿病肾病早期诊断中的应用

Application of Serum Cystatin C, Homocysteine, the Ratio between Microalbuminuria and Creatinine in the Early Diagnosis of the Diabetic Nephrosis

目的 通过定量检测2型糖尿病（T2DM）患者血清胱抑素C（Cys C）、同型半胱氨酸（Hcy）及尿微量清蛋白/肌酐比值（mAlb/Cr）的变化,探讨其在糖尿病肾病（DN）早期诊断中的临床价值.方法 按DN临床诊断标准,将185例T2DM患者分为单纯DM组127例,DN组58例（其中早期DN组32例,临床期DN组26例）.并以DM病程分为＜5年、5-10年、＞10年三组.研究对象血清Cys C,Hcy采用乳胶颗粒增强免疫比浊法及循环酶法检测.尿微量清蛋白（mAlb）采用免疫散射比浊法检测,同时以酶法检测尿肌酐（Cr）,计算尿mAlb/Cr比值.各组间进行统计学分析.结果 DN组血清Cys C,Hcy和尿mAlb/Cr检测结果均明显高于单纯DM组和对照组,单纯DM组也明显高于对照组,三项指标在实验组和对照组间的差异均有统计学意义（F值分别为66.14,76.22和98.35,P＜0.01）.Cys C,Hcy和mAlb/Cr间的相关性分析,单纯DM组为正相关性（r=0.735,0.621和0.716）;DN组也呈正相关性（r=0.761,0.684和0.750）.在不同病程组中,Cys C,Hcy和mAlb/Cr阳性率均随着DM病程的延长而明显增高,其三项指标在不同病程组和对照组间的阳性率差异均具有统计学意义（χ^2值分别为57.11,52.93和49.56,P＜0.01）.结论 血清Cys C,Hcy和尿mAlb/Cr检测可作为DN早期诊断的敏感指标,对于有效监控、预防和延缓DN的发生及治疗效果评价具有重要价值.

Objective By testing the changes in serum Cys C （Cys C） ,homocysteine （Hey） and the ratio between microalbu- minuria and creatinine （mAlb/Cr） of the patients of type 2 diabetic patients （T2DM） ,the text is to discuss the clinical value of of the early diagnosis of the diabetic nephrosis （DN）. Methods According to the clinical diagnostic criteria,divided 185 T2DM patients into 127 pure DM patients and 58 DN patients （among it,32 early-stage DN patients and 26 clinical stage DN patients）. And divided them into three groups （less than 5 years, 5 to 10 years and more than 10 years）according to DN course of disease. The blood serum Cys C and Hey of the subjects were tested by Iatex particle enhanced turbid metric test and enzymatic cycling assay. The microalbumnimuria was tested by immune turbid metric test and the creatinine was tested by enzymatic method to calculate the ratio between microalbumnuria and creatinine （mAlb/Cr）. Had the statistic analysis a- mong the groups. Results The result of the blood serum Cys, Hey and the ratio between microalbumnuria and creatinine （mAlb/Cr） in DN group was higher than pure DN group and contrast group. The pure DN group was also obviously higher than contrast group. The difference of the three indexes in experiment group and contrast group both had statistic meaning （F= 66.14,76.22,98.35 repectively, P〈0.01）. According to the relevance analysis of the blood serum Cys, Hey and the ratio between microalbumnuria and creatinine （mAlb/Cr）, the pure DN group was positive correlation （r= 0. 735,0. 621, 0. 716） and the DN group was also positive correlation （r=0. 761,0. 684,0. 750）. In the different course group,the positive rate of Cys C, Hcy,mA[b/Cr was obviously rising with the extension of the progression of the disease. The positive rate of other indexes in the different course group and contrast group respectively had statistic meaning （χ^2 = 57.11,52.93,49.56 respectively,P〈0. 01）. Conclusion The test of the blood serum Cys C, Hey and the ratio between microalbumnuria and creatinine （mAlb/Cr） carl be used as the sensitive index of the early diagnosis of DN and has important value in effectively controlling,preventing and delaying occurrence of DN and its assessment of treatment effects.