糖尿病肾病患者血浆NGAL和血清CysC水平改变及其早期诊断价值

Changes of Serum NGAL and CysC Levels in Patients with Diabetic Nephropathy and Their Early Diagnostic Value

目的:研究糖尿病肾病(DN)患者血浆中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和血清胱抑素C(CysC)水平变化,分析其对DN的早期诊断价值。方法:选取160例糖尿病(DM)患者按尿微量白蛋白排泄率(UAER)分为DN前期组58例(A组),DN早期组52例(B组)及DN临床组50例(C组),同期选择健康体检者61例为对照组(D组)。比较四组受试者血中NGAL、CysC、尿素氮(BUN)和血肌酐(CREA),及尿中微量清蛋白(UMA)水平的差异,分析血NGAL、CysC与UMA之间的相关关系。结果:(1)A、B、C组受试者NGAL、CysC及UMA水平显著高于D组,且C>B>A,差异均有统计学意义(P<0.05);C组BUN和CREA水平均明显高于A、B、D三组,差异均有统计学意义(P<0.05),而A、B组较D组均无统计学差异(P>0.05)。(2)血NGAL、CysC与尿UMA均存在正相关关系(r=0.59,0.64;P均<0.05)。结论:DN早期患者血浆NGAL与血清CysC水平显著升高,且二者均与尿UMA水平存在正相关关系,可作为评价肾脏损害程度及DN早期诊断的较敏感的生物学标志物,临床推荐应用。

Objective： To study the changes of serum neutrophil gelatinase-associated lipocalin（NGAL）and cystatin C（CysC）levels in patients with diabetic nephropathy（DN）, and their value of diagnosis for early DN. Methods： A total of 160 patients with diabetes mellitus（DM） were selected and divided into before DN group（group A, n=58）, early DN group（group B, n=52） and clinical DN group（group C, n=50） according to the different levels of urinary albumin excretion rates（UAER）, in the same period, 61 healthy persons were chosen as control group（group D）. The levels of serum NGAL, CysC, blood urea nitrogen（BUN）, serum creatinine（CREA）, and urinary microalbumin（UMA） in the four groups were compared; the correlation of serum NGAL and CysC with UMA was analyzed.Results： The levels of serum NGAL, CysC, and UMA in group A, B and C were significantly higher than that in group D, and the levels of the above indexes in group C were higher than those in group B, the levels of the above indexes in group B were higher than those in group A, the differences were statistically significant（P〈0.05）. The levels of BUN and CREA in group C were significantly higher than those in group A, B and D, the differences were statistically significant（P〈0.05）, but there was no significant difference among group A,B and D（P〈0.05）. The levels of serum NGAL and CysC were positively correlated with the levels of UMA（r=0.59, 0.64; P〈0.05）.Conclusion： The levels of serum NGAL and CysC significantly increase in the patients with early DN and are positively correlated with the levels of UMA, which can be used as the sensitive biomarkers for evaluating the degree of renal damage and diagnosis of early DN and is worthy of clinical application.