CysC、mAlb及^(99m)Tc-DTPA在早期糖尿病肾病中的诊断价值

DIAGNOSIS VALUE OF CYSC,MALB AND ^(99m)TC- DTPA IN EARLY DIABETIC NEPHROPATHY

目的探讨尿微量白蛋白(m Alb)、胱抑素C(Cys C)及99mTc-DTPA肾动态显像在早期糖尿病肾病(DN)中的诊断价值。方法选取2012年12月~2013年6月期间我院收治的2型糖尿病患者114例,并分为正常白蛋白尿组(A组,n=42)、微量白蛋白尿组(B组,n=40)、大量白蛋白尿组(C组,n=32)。另选择46例健康者作为对照组。检测受试者m Alb、Cys C,并通过99mTc-DTPA检测肾小球滤过率(GFR)。结果 A组和对照组各指标比较无统计学差异(p>0.05);C组m Alb、Cys C高于其余三组(p<0.05),B组m Alb、Cys C高于A组和对照组(p<0.05)。C组Scr、BUN高于其余三组(p<0.05),但A组、B组、对照组间Scr、BUN比较无统计学差异(p>0.05)。对照组、A组、B组、C组总肾、左肾、右肾GFR均呈现下降趋势,各组间比较,差异显著(均p<0.05)。血清Cys C诊断DN的敏感性高于SCr、BUN、m Alb等指标。GFR与Cys C、m Alb呈负相关(r=-0.689,p=0.009;r=-0.897,p=0.006);Cys C与m Alb间呈正相关(r=0.705,p=0.007)。结论血清Cys C检测联合99mTc-DTPA核素肾动态显像用于早期DN的诊断,具有安全、方便、准确、灵敏等众多优点。

Objective To study the diagnosis value of urinary albumin, serum cystatin C and 99mTc - DTPA renal dynamic imaging in early diabetic nephropathy. Methods From 2012 December to 2013 June in our hospital 114 cases of patients with type 2 diabetes mellitus were selected and were divided into normal albuminuria group （ group A, n = 42）, microalbuminuria group （ group B, n = 40）, a large number of albuminufia group （ group C, n = 32）. Another 46 healthy persons were set as control group. The mAlb, CysC of subjects were detected, and glo- merular filtration rate （GFR） were detected by the determination of 99mTc - DTPA. Results A group and control group each index had no statistical difference （p 〉 0.05 ） ; C group＇ mAlb and CysC were higher than the other three groups （p 〈 0. 05 ）. B group＇ CysC and mAlb were higher than that of A group and the control group （p 〈 0. 05 ）. In group C, Scr and BUN were higher than the other three groups （p 〈0.05）, but the A group, B group, Scr, BUN be- tween the two groups were statistically significant （p 〉 0. 05 ）. In control group, A group, B group, C group, total kidney, right kidney GFR left kidney showed a downward trend, and significant difference was found between the in- ter group （p 〈0. 05）. Sensitivity of serum CysC in the diagnosis of DN was higher than that of SCr, BUN and mAlb index. GFR was negatively correlated with CysC, mAlb （r = - 0. 689, p = 0. 009 ; r = - O. 897, p = 0. 006） ; CysC was positively correlated with mAlb （ r = 0. 705, p = 0. 007）. Conclusion Detection of serum CysC combined with 99roTe - DTPA renal dynamic scintigraphy for diagnosis of early DN, is safety, convenient, accurate, sensitive and has many other advantages.