2型糖尿病肾病血清胱抑素C与颈动脉内膜中层厚度的关系

Cystatin C and its correlation to carotid intima-media thickness in patients with type 2 diabetic nephropathy.

目的探讨2型糖尿病肾病(DN)患者血清胱抑素C(Cys C)与颈动脉内膜中层厚度(IMT)的关系。方法 204例住院的2型糖尿病患者,按24 h尿白蛋白排出量(UAE)分为单纯糖尿病组、早期DN组及临床DN组。检测血清Cys C、生化指标和IMT。再根据肾小球滤过率(e GFR)将DN两组患者划分为CKD组和NKD组,比较上述指标。并采用多元线性回归分析在DN患者中血清Cys C与IMT的相关性。结果在糖尿病3组间,BUN、Cr、血清Cys C随着UAE的增加而增加,e GFR逐渐下降,两两比较均差异有统计学意义(P<0.05)。IMT在临床DN组和早期DN组显著升高,与单纯糖尿病组比较差异有统计学意义(P<0.01)。UAE、BUN、Cr、血清Cys C、IMT在CKD组均显著高于NKD组(P<0.05,P<0.05)。血清Cys C与年龄、病程、收缩压、UAE、BUN、Cr、UA、IMT均呈正相关(r=0.319、0.279、0.283、0.637、0.660、0.806、0.411、0.299,P<0.01),与ALT呈显著负相关(r=-0.212,P<0.01)。多元线性回归分析显示,血清Cys C、年龄、收缩压、Cr、TG是IMT的独立影响因素。结论在2型DN患者中,血清Cys C可作为IMT的一个独立影响因素。对于高血清Cys C的DN患者,我们应密切关注心血管事件的发生。

Objective To investigate the correlation between cystatin C（ Cys C） and carotid intima-media thickness（ IMT） in patients with type 2 diabetic nephropathy（ DN）. Methods A total of 204 type 2 diabetic patients were randomly assigned to simple diabetes group,early diabetic nephropathy group and clinical diabetic nephropathy group according to the daily urinary albumin excretion（ UAE）. Cys C and other biochemical indices were measured. Color Doppler examination was followed to evaluate carotid IMT. All the diabetic nephropathy patients were divided into CKD group and NKD group according to the e GFR. Results Among the three groups,BUN,Cr and Cys C were increased with the increment of UAE,while e GFR was reduced（ P〈0. 05）. IMT was significantly increased in early diabetic nephropathy group and clinical diabetic nephropathy group than that in simple diabetes group（ P〈0. 01）. UAE,BUN,Cr,Cys C and IMT were significantly increased in CKD group than those in NKD group（ P〈0. 01 and P〈0. 05）. Cys C was significantly positively correlated with age,course of the disease,systemic blood pressure（ SBP）,UAE,BUN,Cr,UA and IMT（ r = 0. 319,0. 279,0. 283,0. 637,0. 660,0. 806,0. 411 and 0. 299,respectively,all P〈0. 01）,while negatively correlated with ALT（ r =-0. 212,P〈0. 01）. Multiple linear regression analysis demonstrated that Cys C,age,SBP,Cr and TG were the independent influence factors of IMT. Conclusion In patients with type 2 diabetic nephropathy,Cys C could be used as an independent influence factor for the severity of IMT. Type 2 diabetic nephropathy patients with high Cys C level required more prevention of cardiovascular events.