血清胱抑素C、TNF-α及血尿酸在2型糖尿病肾病检测中的意义

Diagnostic value of serum Cystatin C,TNF-α and Uric Acid in type 2 diabetic patients with nephropath

目的探讨血清胱抑素C,TNF-α及血尿酸在2型糖尿病肾病检测中的意义,以供临床参考。方法对我院278例糖尿病患者,据糖尿病肾病分期标准分为：糖尿病正常蛋白尿98例,糖尿病肾病Ⅲ期61例,糖尿病肾病Ⅳ期65例,糖尿病肾病Ⅴ期组54例,并选取我院同期健康体检者51例作为对照组。所有试验者均进行血清胱抑素C、TNF-α、血尿酸检测,对比各组之间有无差异。同时对尿微量白蛋白/肌酐、血清胱抑素C、TNF-α、血尿酸进行相关性分析及诊断性能评价。结果经分析,血清胱抑素C、血尿酸在正常对照组、糖尿病正常蛋白尿组、糖尿病肾病Ⅲ期逐渐升高,但无统计学差异（P〉0.05）,在糖尿病Ⅳ~Ⅴ期明显升高,差异有统计学意义（P〈0.05）。TNF-α随着疾病的进展逐渐升高,糖尿病正常蛋白尿组与糖尿病肾病Ⅲ期组无统计学差异,其余各组两两相比均有统计学差异。以上3指标两两呈正相关（P〈0.01）。ROC曲线分析表明,尿微量白蛋白/肌酐、TNF-α、血清胱抑素C及血尿酸的曲线下面积分别为1.000、0.909、0.816、0.687。结论尿微量白蛋白/肌酐对糖尿病肾病诊断价值最高,并且已列入指南。TNF-α浓度的变化在糖尿病肾病病程中更敏感,临床上可参考血清TNF-α浓度或同时检测血清血清胱抑素C来判断糖尿病肾脏的损伤程度。

Objective To assess serum Cystatin C, Uric Acid and TNF-α as screening markers for renal dysfunction in patients with type 2 diabetes mellitus （T2DM）. Methods 278 patients with T2DM and 51 healthy volunteers were enrolled in this study. These patients were divided into four groups according to the level of UAER and SCr： Normoalbuminuric group, Diabetic Nephropathy （DN）Ⅲ group, DN Ⅳ group, DN V group. Blood samples were collected for testing Cys C,TNF-α, Uric Acid. and urine samples were for microalbumin excretion rate （UAER）, albumin-creatinine ratio（ACR） .Results Compared with control group, serum Cystatin C, Uric Acid increased in Normoalbuminuric group and DN Ⅲ group, but there was no statistical significance （P 〉 0.05）. whereas, the two parameters increased significantly in DN IV group and DN V group （P 〈 0.05）. TNF- α increased significantly with the progress of urinary albumin excretion, but there was no statistical significance between normoalbuminuric group and DN Ill group （P 〉 0.05）.Pearson＇s correlation analysis showed that significant positive correlations between these three parameters （P〈 0.01）. ROC＇s curve area for ACR ,TNF- α, Serum Cystatin C,and Uric Acid were 1.000, 0.909, 0.816 and 0.687 respectively. Conclusion TNF- α is a more sensitive marker for early renal damage in diabetes. Detection of TNF- α and serum Cystatin C both can monitor renal dysfunction in Type 2 Diabetes Mellitus.