血清胱抑素C早期诊断糖尿病肾病的价值

Value of serum cystatin C in early diagnosis of diabetic nephropathy

目的探讨血清胱抑素C（Cys-C）在糖尿病肾病（DN）患者中的变化和临床应用价值。方法选取符合Mogensen原则中Ⅲ、Ⅳ期的75例DN患者作为研究对象（观察组）,根据24 h尿白蛋白排泄率（UAER）及尿蛋白由高到低分为A、B、C三组各25例,另选择门诊健康体检者28例作为对照组,测定所有入选对象的血清Cys-C、肌酐（Cre）、尿素氮（BUN）、空腹血糖（FBG）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和糖化血红蛋白（Hb Alc）等指标。结果观察组的FBG、Hb Alc、Cys-C、Cre和BUN水平显著高于健康对照组（P〈0.05或0.01）,HDL-C水平显著低于健康对照组（P〈0.01）。观察组的TC、TG和LDL-C与健康对照组比较差异无统计学意义（P〉0.05）。观察组（A＋B＋C组）中三项指标检测阳性率分别为76.0%（57/75）、65.3%（49/75）和62.7%（47/75）,差异无统计学意义（χ2=3.4314,v=2,P=0.1798）。C组三项指标的检测阳性率分别为36%、12%和8%,差异有统计学意义（χ~2=7.5527,v=2,P=0.0229）,进一步两两比较发现,C组Cys-C检测的阳性率高于Cre和BUN的阳性率（均P〈0.05）。观察组患者24 h UAER水平与Cys-C、Cre和BUN之间均存在正相关关系（r分别为0.95、0.86和0.68,均P〈0.01）。结论血清Cys-C是反映肾小球损伤的重要标志物,其能够更早、更准确、更敏感地监测肾脏的损伤情况,对DN的发生、发展及预后有一定的参考价值。

Objective To investigate the clinical significance and level changes of serum cystatin C（ Cys-C） on patients with diabetic nephropathy（ DN）.Methods 75 DN patients with stage Ⅲ or Ⅳ according to Mogensen principle were selected as study objects（ observation group）,and they were divided into group A,group B,and group C according to 24 h urinary albumin exeretion rate（ UAER） and urinary protein high to low.Meanwhile,28 healthy people who received physical examination in clinic at the same time were selected as control group.Then,indexes of all study objects like serum Cys-C,creatinine（ Cre）,urea nitrogen（ BUN）,fasting blood glucose（ FBG）,total cholesterol（ TC）,triglyceride（ TG）,low density lipoprotein cholesterol（ LDL-C）,high-density lipoprotein cholesterol（ HDL-C） and glycosylated hemoglobin（ Hb Alc） etc.were tested.Results Levels of FBG,Hb Alc,serum Cys-C,Cre and BUN of the observation group were significantly higher than those of the control group（ P〈0.05 or 0.01）,but HDL-C level was significantly lower than that of the control group（ P〈0.01）.Difference of TC,TG and LDL-C of the observation group and the control group was not statistically significant（ P〉 0.05）. And positive rate of TC,TG and LDL-C of the observation group（ group A＋group B＋group C） was 76.0%（ 57 / 75）,65.3%（ 49 / 75） and62. 7%（ 47 / 75）,respectively,difference was not statistically significant（ χ2= 3.4314,v = 2,P = 0.1798）. Positive rate of TC,TG and LDL-C of the group C was 36%,12% and 8%,respectively,difference was statistically significant（ χ2= 7.5527,v = 2,P = 0.0229）.Further comparison showed that positive rate of Cys-C was higher than that of the Cre and BUN in the group C（ all P〈0.05）.Level of 24 h UAER was positively correlated with Cys-C,Cre and BUN（ r was 0.95,0.86 and 0.68 respectively,all P〈0.01）.Conclusion Serum Cys-C is an important marker of reflecting glomerular damage. It can monitor the renal damage earlier,more accurate and more sensitive,which has certain reference value on genesis,development and prognosis of DN.