血清胱抑素C检测在评价2型糖尿病早期肾功能损害中的应用  

Applicaton of serum cystatin C detection in assessment of early renal function injury in patients with type 2 diabetes mellitus

作　　者：杜国有[1] 顾向明[1] 黄阶胜[1] 彭明[1] 朱小华[2] 梁振钟[2] 丘利玲[1] 许翠锦[1] 

机构地区：[1]广东省中山市中医院检验科,528400 [2]广东省中山市中医院内科,528400

出　　处：《国际检验医学杂志》2008年第9期798-800,共3页International Journal of Laboratory Medicine

基　　金：中山市医学科研基金立项课题(2005064)

摘　　要：目的探讨血清胱抑素C(CysC)水平测定在2型糖尿病患者不同肾损害期中的临床诊断价值。方法采用乳胶颗粒增强免疫透射比浊法(PETIA)测定2型糖尿病患者150例血清CysC水平,同时测定血清肌酐(SCr)、尿素氮(Bun)、β2-微球蛋白(β2-MG)及晨尿微量清蛋白,采用受试者工作特征曲线(ROC)评价CysC的诊断效能。结果2型糖尿病组血清CysC水平明显高于健康对照组(P<0.01),其中无糖尿病肾病(无DN)组、Ⅲ期DN组以及Ⅳ、Ⅴ期DN组间血清CysC水平比较差异有统计学意义(P<0.01)。在无DN组中,血清CysC、β2-MG、SCr、Bun四项指标的异常检出率无显著差异(P>0.05),但在Ⅲ期DN组中,CysC、β2-MG的异常检出率明显高于SCr和Bun(P<0.01)。以尿微量清蛋白为标准,2型糖尿病患者中DN的诊断敏感性和特异性,血CysC(以1.22mg/L为界值)分别为72.1%、88.6%,β2-MG(以2.82mg/L为界值)分别为79.0%、92.3%,SCr(以101μmol/L为界值)分别为46.2%、93.5%,Bun(以6.19mmol/L为界值)分别为41.7%、84.3%。CysC、β2-MG诊断DN的敏感性显著高于SCr和Bun(P<0.01),4项指标诊断DN的特异性差异无统计学意义(P>0.05)。CysC、β2-MG、SCr、Bun的ROC分别为0.781、0.812、0.645、0.619。结论血清CysC是一个灵敏、准确、可靠的反映肾小球滤过功能的指标,有助于2型糖尿病肾病的早期诊断。Objective To explore the clinical diagnostic value of serum cystatin C detection in different stages of renal impairment in patients with type 2 diabetes mellitus. Methods The serum level of cystatin C was detected by particle-enhanced turbidimetric immunoassay （PETIA） ; while serum creatinine （SCr）, blood urea nitrogen （Bun）, β2-microglobulin （β2-MG）, morning urine microalbumin were measured in 150 patients with type 2 diabetes mellitus. The area under receiver operating characteristic curve （ROC） was applied to evaluating the diagnostic efficiency of cystatin C. Results The serum cystatin C level was much higher in diabetes group than that of healthy control group （P〈0.01）. The differences among non-diabetic nephropathy （non-DN） group, DN group （including DN stage Ⅲ group, stage Ⅳ group and stage Ⅴ group） were statistically significant in serum cystatin C level （P〈 0.01）. The abnormal detection rates for serum cystatin C, β2- MG, SCr and Bun were not statistically different in non-DN group （P〉0.05）, but the abnormal rates for serum cystatin C and β2- MG were significantly higher than those of SCr and Bun in stage Ⅲ group （P〈0.01）. With a cutoff value of 1.22 mg/L, sensitivity and specificity were 72. 1% and 88. 6% for serum cystatin C; with a cutoff value of 2.82 mg/L, sensitivity and specificity were 79.0% and 92.3% for β2- MG; with a cutoff value of 101 μmol/L, sensitivity and specificity were 46.2% and 93.5% for SCr; and with a cutoff value of 6.19 mmol/L, sensitivity and specificity were 41.7% and 84.3% for Bun, respectively. The sensitivity of serum cystatin C and β2-MG was significantly higher than that of SCr and Bun（P〈0.01）. The specificity for above four markers was not statistically different （P〉0.05）. The area under ROC for eystatin C, β2-MG, SCr and Bun was 0. 781, 0. 812, 0. 645 and 0. 619 respectively. Conclusion Serum cystatin C is a sensitive, accurate and reliable marker for glomerular filtration rate, Which is help

关 键 词：抑素类 肾小球滤过率 糖尿病 2型 

分 类 号：R587.1[医药卫生—内分泌]