半胱氨酸蛋白酶抑制剂C及相关评估方程在糖尿病肾病患者中的适用性评价  

Applicability of serum Cys C and Cys C-based equations for estimation of glomerular filtration rates in patients with diabetic nephropathy

作　　者：刘志明[1] 杨莉[1] 

机构地区：[1]东南大学附属南京江北人民医院检验科,江苏南京210048

出　　处：《中国临床研究》2014年第12期1451-1454,共4页Chinese Journal of Clinical Research

摘　　要：目的探讨半胱氨酸蛋白酶抑制剂C(cysteine proteinase inhibitors C,Cys C)及其肾小球滤过率(GFR)评估方程在糖尿病肾病(DN)及其分期中的应用。方法选取2014年1月至9月住院的糖尿病(DM)患者202例。根据Mogensen标准对糖尿病患者进行分组:单纯DM组(n=113),早期DN组(n=70),临床DN组(n=19)。并以CKD-EPIcys方程评估的GFR(e GFR)值为标准,参考美国K/DOQI标准,将糖尿病患者分为CKD I期(n=51),II期(n=81),III^V期组(n=70)。血清Cys C采用透射比浊法检测,尿微量白蛋白(m Alb)采用免疫比浊法检测。比较各临床分期的Cys C水平。通过CKD-EPIcys方程和Fengcys、Macys、ZHcys方程评估入选患者预测GFR(e GFR),并进行比较。结果血清Cys C水平早期DN组[(1.17±0.35)mg/L]及临床DN组[(1.74±0.96)mg/L]均显著高于单纯DM组[(1.01±0.23)mg/L](P均<0.01)。由CKD-EPIcys方程及Fengcys、Macys、ZHcys方程估算的e GFR值,单纯DM组与早期DN组、临床DN组相比较,差异均有统计学差异(P均<0.01);在CKD I^V期,Macys方程、ZHcys方程估算的e GFR值均高于CKD-EPIcys方程(P均<0.01);在CKD I期,Fengcys方程e GFR值与CKDEPIcys方程差异无统计学意义(P>0.05),但在CKD II^V期则显著高于CKD-EPIcys方程(P均<0.01)。结论血清Cys C水平及其评估方程可较好的反映出DN的早期肾损害,在评估DN患者GFR时,与CKD-EPIcys方程相比,Fengcys、Macys、ZHcys方程存在高估现象,在DN患者中应用有待进一步的研究证实。To explore the application of cysteine proteinase inhibitors C （ Cys C） and Cys C-based glomerular filtration rate （GFR） estimation equations for diabetic nephropathy （DN） and its staging. Methods A total of 202 patients with diabetic mellitus admitted between January and September 2014 were selected. The DM patients were divided into simple DM group（ n = 113）, early DN group （n = 70） and clinical DN goup（ n = 19 ） according to Mogensen stadard. Furthermore, on the bases of the GFR value estimated by CKD-EPI equation （eGFR） With reference to the K/DOQI standard, the DM patients were divided into CKD stage Ⅰ （n = 51 ）, stage II （n = 81 ）, stage Ⅲ-Ⅴ （n = 70） groups. Serum Cys C was detected by transmission turbidimetry, and urinary microalbumin was detected by lmmunoturbidimetry for all patients. The Cys C levels of different clinical stage were compared. The eGFR values estimated by CKD-EPI, Feng, Ma and ZH equations were compared. Results The Cys C levels in early DN group[ （ 1.17 ± 0.35 ） mg/L] and clinical DN group [ （1.74 ± O. 96）mg/L] were all significantly higher than that in simple DM group [ （1. O1± 0. 23） mg/L] （all P 〈 0.01 ）. There were statistical differences in eGFR values estimated by CKD-EPI, Feng, Ma and ZHcys equations between simple DM group and early DN group, clinical DN group （ all P 〈 0. 01 ）. In CKD I - V stages, the eGFR values estimated by Ma and ZH equations were all significantly higher than those estimated by CKD- EPI equation （all P 〈 0.01 ）. In CKD I stage, there was no significant differece in eGFR values between Feng equation and CKD-EPI equation （P 〉 O. 05）, while the eGFR values estimated by the Fenge equation in CKD Ⅱ-Ⅴ stages were significantly higher than those by CKD-EPI equation （all P 〈 O. O1 ）. Conclusions Serum cystatin C level and Cys C-based equations can better reflect early renal damage in patients with DN. The eGFR values derived from Feng, Ma and ZH, equations might be over

关 键 词：半胱氨酸蛋白酶抑制剂C 肾小球滤过率 糖尿病肾病 估算的肾小球滤过率 

分 类 号：R692[医药卫生—泌尿科学]