血清和尿半胱氨酸蛋白酶抑制剂C对糖尿病患者早期肾损伤的诊断价值  

Value of serous and urinary cystatin C for the diagnosis of early kidney injury in diabetic patients

作　　者：汪华林[1] 黄元寿[1] 谢辉[1] 俞小敏[1] 刘长波[1] 肖长长[1] 谭树芬[1] 

机构地区：[1]广州医学院第一附属医院肾内科,510120

出　　处：《中华生物医学工程杂志》2009年第2期103-107,共5页Chinese Journal of Biomedical Engineering

摘　　要：目的观察糖尿病患者血清和尿半胱氨酸蛋白酶抑制剂C（cystatinC）的浓度变化并与临床常用反映肾功能改变的指标进行比较，探讨其对糖尿病早期肾损伤的临床评估价值。方法选择本院首次确诊为糖尿病患者82例，按24h尿白蛋白定量程度分成3组，以健康志愿者为对照，分别观察血清cystatinc、血清肌酐（Scr）、尿cystatinC、N-乙酰-β-葡萄糖苷酶（NAG）、α1微球蛋白（MG），99m^Tc肾小球滤过率（GFR），内生肌酐清除率（Ccr）-GFR等临床指标并行统计分析。结果尿cystatin C浓度及其异常率的升高早于血清cystatin C。血清cystatin C与99m^Tc-GFR的相关性较Ccr-GFR与99m^Tc-GFR的相关性好（r=-0．88和r=0．84，P〈0．01）。尿cystatin C与NAG的相关性和尿cystatin C与α1-MG的相关性之间差异无统计学意义（r=0．89和r=0．90，P〉0．05）。血清cystatinC的工作特征曲线下面积（AUC^ROC）大于Ccr-GFR的AUC^ROC（0．897±0．094和0．757±0．228，P〈0．01）；尿cystatin C的AUC^ROC。大于NAG的AUC^ROC（P〈0．05），与α1-MG的AUC^ROC。差异无统计学意义（P〉0．05）。尿cystatin C的似然比（LR）大于血清cystatinc的LR。结论血清和尿cystatin C水平可较早期地反映糖尿病患者肾功能的损伤，其反映肾小管功能的损伤早于肾小球功能的损伤。Objective To detect the changes of serous and urinary cystatin C concentration compared with clinic general renal function indexs, and to evaluate the value of cystatin C for the diagnosis of early kidney injuryin diabetic patients. Methods Eighty-two patients preliminayily diagnosed as diabetes were divided into three groups according to the degree of 24 hours urinary microalbumin quantitation. Twenty- eight healthy volunteers were selected as control. Serous cystatin C, serous creatinine, urinary cystatin C, urinary N-acetyl-β-d-glucosaminidase （NAG）, urinary α1-microglobulin（α1-MG）, 99m^Tc-DTPA glomerular filtration rate （99m^Tc-GFR） and creatinine clearance rate resulted from Cockcroft-Gault equation （Ccr-GFR） were measured and statistical analysis was performed. Results The concentration and abnormal rate of urinary cystatin C increased before those of serous cystatin C were higher. Correlation between serous cystatin C and 99m^Tc-GFR was superior to that between Ccr-GFR and 99m^Tc-GFR （r=-0.88 vs r=0.84, P〈 0.01 ）. Correlation between urinary cystatin C and NAG was similar to that between urinary cystatin C and α1- MG （r=0.89 vs r=0.90, P〈0.01）. Area under curve of receiver operating characteristic （AUC^ROC） of serous cystatin C and Ccr-GFR was significantly different （0.897 ± 0.094 vs 0.757± 0.228, P〈0.01）. AUC^ROC of urinary cystatin C was superior to that of NAG （P〈0.05）, and no difference to that of α1-MG was found （P〉0.05）. Likelihood ratio （LR） of urinary cystatin C was superior to that of serous cystatin C. Conclusion Serous and urinary cystatin C concentration can diagnose early diabetic kidney injury, which can earlier reflect impairment of kidney tubule than that of glomerulum.

关 键 词：半胱氨酸蛋白酶抑制剂 糖尿病 肾功能试验 ROC曲线 肾小管 

分 类 号：R587.2[医药卫生—内分泌]