血清胱抑素C、尿微量白蛋白在高血压早期肾损害中的诊断价值

The Diagnostic Value of Serum Cystatin C and Microalbuminuria in Early Kidney Injury among Hypertensive

目的探讨血清胱抑素C(Cys C)、24h尿微量白蛋白(24h MAU)对高血压早期肾功能损害的诊断价值。方法收集高血压患者234例,用同位素肾图检查作为金标准测定肾小球滤过率(GFR),按照GFR数值分成三组:肾功能无损害组、肾功能受损代偿组、肾功能受损失代偿组,同时测定每组血清Cys C、24h MAU、血肌酐及尿素氮,并分别计算每个指标在诊断高血压早期肾损害的灵敏度、特异度。结果随着GFR下降,血清Cys C、24h MAU、血肌酐及尿素氮均值逐渐升高(P<0.01)。将肾功能受损代偿组和肾功能受损失代偿组合并为肾功能受损组。肾功能无损害组79例患者血清中Cys C浓度异常者占3.80%,24h MAU浓度异常者占11.40%,血肌酐浓度异常者占0.00%,尿素氮异常者占0.00%;肾功能受损组155例患者血清中Cys C浓度异常者占45.16%,24h MAU浓度异常者占42.58%,血肌酐浓度异常者占18.06%,尿素氮异常者占18.71%。差异均有统计学意义(P<0.01)。四项指标诊断高血压早期肾功能损害的灵敏度分别为45.20%、42.60%、18.10%、18.70%,特异度分别为96.20%、88.60%、100.00%、100.00%,四项指标诊断高血压早期肾功能损害的ROC曲线下面积分别为0.76、0.66、0.63、0.69。结论血清Cys C、24h MAU是敏感且特异的反映肾小球滤过功能的指标,尤其是Cys C对高血压早期肾功能损害具有较高的诊断价值。

Objective To evaluate the clinical significance of serum Cystatin C（ Cys C） and 24 h microalbuminuria（ 24 h MAU） in diagnosis of early renal impaired patients with hypertension. Methods The study was performed on 234 hypertension patients. Checking for isotopes renal figure was used as the gold standard to measure the kidney estimated glomerular filtration rate（ GFR）,classifying the patients into three groups according to GFR numerical,isotope simultaneous determination of serum Cys C,24 h MAU,creatinine（ Scr） and blood urea nitrogen（ BUN） of each group,and calculating the sensitivity,specific degrees of each index in the diagnosis of early renal impairment in patients with hypertension,making a comparison to evaluate the value of serum Cys C,24 h MAU in hypertension patients in early renal damage diagnosis. Results The mean levels of Cys C,24 h MAU,Scr and BUN increased with the decrease of GFR（ P 0. 01）. Combining the second and third group as a renal damage group,and the first group as nondestructive group for renal function. The ratio of patients with abnormal Cys C,24 h MAU,Scr and BUN were 3. 8%,11. 4%,0. 0% and 0. 0% in the first group（ n = 79）,45. 16%,42. 58%,18. 06%and 18. 71% in the renal damage group（ n = 155）,respectively. The sensitivity of four indexes of diagnosing patients with primary hypertension and early renal impairment were 45. 2%,42. 6%,18. 1% and 18. 7%,the specificity were 96. 2%,88. 6%,100% and 100%. Area of ROC curves of four indexes of diagnosing patients with primary hypertension and early renal impairment were 0. 759,0. 655,0. 630 and 0. 689. Conclusions Serum Cys C,24 h MAU are sensitive and specific marks of renal injury. They are more significant than the other two indexes for renal impairment in patients with hypertension,of which the serum Cys C inhibition diagnosis is more worth than 24 h MAU.