胱抑素C及同型半胱氨酸在糖尿病肾病中的检测及其临床意义

Clinical significance of detection of serum cystatin C and homocysteic acid in patients with diabetic nephropathy

目的探讨糖尿病肾病患者胱抑素C与同型半胱氨酸的水平变化及临床意义。方法选取糖尿病患者102例。根据24 h尿微量白蛋白排泄率将患者分为3组:单纯DM组36例;早期DN组24例;中晚期DN组42例。检测Cys C、Hcy水平,并结合临床资料进行相关性分析。结果 DM患者Cys C、Hcy的水平低于早期DN患者(P=0.003,P=0.006)及中晚期DN患者(P=0.000),早期DN患者也低于中晚期DN患者(P=0.019)。DM患者肾小球滤过率的水平高于DN患者(P=0.000)。同时,DN患者Cys C、Hcy的水平与e GFR(P=0.009,P=0.000)呈负相关,与Bun的水平(P=0.004,P=0.003)、Crea(P=0.006,P=0.001)呈正相关。结论血清Cys C、Hcy能较敏感地反映肾脏早期损害过程,可作为早期诊断糖尿病肾病的指标之一,同时h Hcy参与DN肾脏损害的进展。

Objective To evaluate the clinical value of serum cystatin C（ Cys C） and homocysteic acid（ Hcy） in the patients with diabetic nephropathy（ DN）,and investigate its clinical significance. Methods One hundred and two patients defined as diabetic mellitus were enrolled and assigned into simple diabetic mellitus group（ n = 36）,early stage of diabetic nephropathy group（ n = 24）,and middle-late stage of daibetic nephropathy group（ n = 42） according to 24 hour urinary albumin excretion ratt（ u ARE）. Serum levels of Cys C and Hcy were detected,then the correlation with clinical data was analyzed. Results The serum levels of Cys C and Hcy in simple diabetic mellitus group was lower than that early stage of diabetic nephropathy group（ P = 0.03,P = 0.006）and middle-late stage of diabetic nephropathy group（ P = 0.00）. The serum levels of Cys C in early stage of diabetic nephropathy group was lower than that middle-late stage of diabetic nephropathy group（ P = 0. 019）. Estimated glomerular filtration rate（ e GFR） in simple diabetic mellitus group was higher than that diabetic nephropathy group（ P = 0.00）. The serum levels of Cys C and Hcy in diabetic nephropathy group were reversely correlated with e GFR（ P = 0.009,P = 0.00）,positively correlated with blood urea nitrogen and creatinine（ P = 0.006,P = 0.001）.Conclusions Cys C and Hcy can be an important indicator for the early diagnosis of inpairment in diabetic nephropathy. High Hcy may be an acceleration progression of renal damage.