血清胱抑素C在2型糖尿病肾病早期诊断中的临床价值探讨  

Clinical value of serum cystatin C in early diagnosis of diabetic nephropathy in type 2 diabetes

作　　者：周蓓[1] 陈学峰[1] 杭宇[1] 方晨圆[1] 鲁大胜 陶少平[1] 

机构地区：[1]皖南医学院第二附属医院内分泌科,安徽省芜湖市241000

出　　处：《中华全科医学》2014年第9期1379-1381,共3页Chinese Journal of General Practice

基　　金：皖南医学院中青年科研基金(WK2013F31);安徽省高校自然科学基金(KJ2013B305)

摘　　要：目的探讨血清胱抑素C在早期诊断2型糖尿病患者肾损伤的临床价值,同时分析血清胱抑素C与肾小球滤过率之间的关系。方法选择100例皖南地区2型糖尿病患者,根据所选患者24小时尿白蛋白排泄率,将患者分为正常白蛋白尿组(32例)、微量白蛋白尿组(39例)及大量白蛋白尿组(29例)。分别检测3组患者的血清胱抑素C、血尿素氮、血肌酐、肌酐清除率及肾小球滤过率等临床指标,同时对血清胱抑素C与肾小球滤过率的相关性进行统计学分析。结果在所选皖南地区2型糖尿病患者中,随着患者24小时尿白蛋白排泄量的增加,3组患者的肾小球滤过率及肌酐清除率均出现明显降低,血清胱抑素C水平出现升高,并与肾小球滤过率呈现明显的负相关性(P<0.01)。而且血清胱抑素C、肾小球滤过率、肌酐清除率存在显著性差异;在单纯性2型糖尿病患者中,血肌酐及血尿素氮的检出率均较低,但肾小球滤过率不同的患者,胱抑素C水平却有明显差别,eGFR<60 ml/(min·1.73 m2)患者的血清CysC水平明显高于eGFR≥60 ml/(min·1.73 m2)的患者,且该差异具有统计学意义。结论血清胱抑素C是一种能灵敏反映肾小球滤过率的内源标记物,其不仅与肾小球滤过率呈现良好的临床相关性,而且能反映2型糖尿病患者的不同肾损伤程度,进而用于单纯性2型糖尿病患者肾小球滤过率下降的早期诊断。Objective To discuss the clinical value of serum cystatin C（ CysC） in the early diagnosis of renal impairment in patients with type 2 diabetes,and analyze the relationship between serum CysC level and glomerular filtration rate（ eGFR）. Methods According to 24 h urines albumin excretion rate,100 type 2 diabetic patients in southern Anhui areas were divided into non-albuminuria group（ n = 32）,microalbuminuria group（ n = 39） and macroalbuminuria group（ n =29）. The levels of serum CysC,blood urea nitrogen（ BUN）,serum creatinine（ Scr）,creatinine clearance rate（ Ccr） and eGFR of the three groups were tested. The correlation between eGFR and serum Cys C was also analyzed statistically. Results Among the three groups,both eGFR and Ccr declined with the increasing of 24 h urines albumin excretion rate,but the CysC level increased and presented a negative correlation with eGFR（ P 〈0. 01）. There was also a significant difference in serum CysC,eGFR and Ccr among the three groups. The detection rates of Scr and UBN were low for type 2 diabetic patients with non-albuminuria,but there was obvious difference of CysC for the patients with different eGFR. The CysC level of the patients with eGFR 60 ml /（ min·1. 73 m^2） was apparently higher than that of the patients with eGFR≥60 ml /（ min·1. 73 m^2）,and this difference was statistical significance. Conclusion The serum CysC was a sensitive endogenesis marker of eGFR,it not only had a good clinical correlation with eGFR,but also showed the different degree of renal impairment for type 2 diabetic patients,and can early diagnose the decline of eGFR in type 2 diabetic patients with non-albuminuria.

关 键 词：糖尿病肾病 血清胱抑素C 血肌酐 蛋白尿 

分 类 号：R587.2[医药卫生—内分泌]