血清胱抑素-C和同型半胱氨酸联合检测对儿童糖尿病早期肾损伤的诊断价值

Diagnostic value of combined detection of serum cystatin-C and homocysteine on early renal injury in diabetic children

目的探讨联合检测血清胱抑素-C(Cys-C)和同型半胱氨酸(Hcy)对儿童糖尿病患者早期肾损伤的临床诊断价值。方法选择2010年1月至2016年12月濮阳市中医医院收治的糖尿病患儿80例为研究对象,根据尿蛋白排泄率(UAER)将患儿分为<30 mg组(n=20)、30~300 mg组(n=35)和>300 mg组(n=25),另选择40例健康儿童为对照组,检测各组受试者血清同型半胱氨酸(Hcy)、胱抑素-C(Cys-C)、肌酐(Scr)和内生肌酐清除率(Ccr),分析联合检测Cys-C和Hcy对糖尿病患儿早期肾损伤的诊断价值。结果<30 mg组患儿血清Cys-C、Hcy水平高于对照组(P<0.05);<30 mg组患儿Scr、Ccr水平与对照组比较差异无统计学意义(P>0.05);30~300 mg组、>300 mg组患儿血清Cys-C、Hcy、Scr水平高于对照组和<30 mg组,Ccr水平低于对照组和<30 mg组(P<0.05);>300 mg组患儿血清Cys-C、Hcy、Scr水平高于30~300 mg组,Ccr水平低于30~300 mg组(P<0.05);血清Hcy、Cys-C单独检测诊断糖尿病患儿肾损伤的阳性率分别为92.86%和96.55%,Hcy和Cys-C联合检测诊断糖尿病患儿肾损伤的阳性率为98.65%,血清Hcy、Cys-C联合检测诊断糖尿病患儿肾损伤的阳性率高于单独检测Hcy、Cys-C(P<0.05)。血清Hcy和Cys-C联合检测诊断糖尿病患儿早期肾损伤的灵敏度和诊断准确率均高于Hcy、Cys-C单独检测(P<0.05)。结论糖尿病早期肾损伤患儿血清Cys-C、Hcy水平随着UAER的升高呈渐进式升高,联合检测Hcy与Cys-C是诊断糖尿病患儿早期肾损伤的可靠指标。

Objective To investigate the clinical diagnostic value of combined detection of serum cystatin-C(Cys-C)and homocysteine(Hcy)on early renal injury in diabetic children.Methods Eighty diabetic children admitted to Puyang Traditional Chinese Medicine Hospital from January 2010 to December 2016 were selected as the study subjects,which were divided into<30 mg group(n=20),30-300 mg group(n=35)and>300 mg group(n=25)according to the urinary albumin excretion rates(UAER).Simultaneously,forty healthy children were selected as control group.Serum Hcy,Cys-C,serum creatinine(Scr)and endogenous creatinine clearance rates(Ccr)of patients in each group were detected.The diagnostic value of combined detection of Cys-C and Hcy on early renal injury in diabetic children was analyzed.Results The levels of serum Cys-C and Hcy in the<30 mg group were significantly higher than those in the control group(P<0.05).There was no significant difference in the levels of Scr and Ccr between the<30 mg group and the control group(P>0.05).The levels of serum Cys-C,Hcy and Scr in the 30-300 mg group and the>300 mg group were significantly higher than those in the control group and the<30 mg group,and the level of Ccr was significantly lower than that in the control group and the<30 mg group(P<0.05).The levels of serum Cys-C,Hcy and Scr in the>300 mg group were significantly higher than those in the 30-300 mg group,and the level of Ccr was significantly lower than that in the 30-300 mg group(P<0.05).The positive rate of individual detection of serum Hcy and Cys-C for the diagnosis of renal injury in diabetic children was 92.86%and 96.55%respectively.The positive rate of combined detection of Hcy and Cys-C for the diagnosis of renal injury in diabetic children was 98.65%.The positive rates of combined detection of serum Hcy and Cys-C for the diagnosis of renal injury in diabetic children was lower than that of individual detection of serum Hcy and Cys-c(P<0.05).The sensitivity and diagnostic accuracy of combined detection of Hcy and Cys-C for the diagnosis of renal injury in diabetic children were higher than those of individual detection of Hcy and Cys-C(P<0.05).Conclusion The sensitivity and specificity of combined detection of Hcy and Cys-C for the diagnosis of early renal injury in diabetic children are higher,which can be used as a reliable index for the diagnosis of early renal injury in diabetic children.