比较血清半胱氨酸蛋白酶抑制剂C和肌酐对糖尿病肾损害的诊断效能  

Comparison of diagnostic efficacy of cystatin C and creatinine in diabetic nephropathy

作　　者：陈宣蓉[1] 林硕[1] 王曼曼[1] 曾龙驿[1] 

机构地区：[1]中山大学附属第三医院内分泌科,广州510630

出　　处：《新医学》2015年第3期149-152,共4页Journal of New Medicine

基　　金：广东省自然科学基金项目(S2011010004811)

摘　　要：目的比较血清半胱氨酸蛋白酶抑制剂C(Cys C)及血清肌酐对2型糖尿病肾损害的诊断效能。方法记录279例2型糖尿病患者的一般资料、测定其GHb A1c、血清Cys C、血清肌酐、尿白蛋白排泄率(UAE)、肾小球滤过率(GFR),将患者分为正常尿蛋白组、微量尿蛋白组及大量尿蛋白组进行分层分析。采用Spearman秩相关分析分析血清肌酐、Cys C及GFR之间的相关性,绘制受试者工作特征(ROC)曲线,比较Cys C、Scr及UAE对于肾功能损害[GFR<60 ml/min·(1.73m2)]的诊断效能。采用多重线性回归分析Cys C的影响因素。结果正常尿蛋白组、微量尿蛋白组及大量尿蛋白组间的年龄、病程、GHb A1c、Cys C、血清肌酐、24 h UAE比较差异有统计学意义(P均<0.05)。血清肌酐与Cys C呈正相关(rs=0.862,P<0.001),Cys C及血清肌酐与GFR呈负相关,Cys C及血清肌酐随GRF下降而升高(rs-Cys C=-0.816,rs-血清肌酐=-0.747,P均<0.001),Cys C与GRF的相关性较血清肌酐好。ROC曲线下面积显示Cys C对肾功能损害[GFR<60 ml/min·(1.73m2)]的诊断效能较血清肌酐及24 h UAE好(0.963 vs.0.929 vs.0.720,P均<0.001);计算Cys C的诊断切点值为1.18 mg/L,敏感度为93.3%,特异度为87.9%;血清肌酐的诊断切点值为78.9μmol/L,敏感度为85.6%,特异度为92.6%。多重线性回归结果显示对Cys C有影响的因素包括血尿酸、血清白蛋白、年龄、GHb A1c,其中血尿酸的影响最大(标准化偏回归系数0.447)。结论血清Cys C对2型糖尿病患者的肾功能损害[GFR<60 ml/min·(1.73 m2)]的评估效能优于血清肌酐。对于高尿酸血症的糖尿病患者,Cys C的评估效能可能会下降。Objective To statistically compare the clinical efficacy of cystatin C（ Cys C） and serum creatinine in the diagnosis of type 2 diabetic nephropathy. Methods The general data of 279 patients diagnosed with type 2 diabetes mellitus were recorded. The GHb A1 c,serum Cys C,serum creatinine,urinary albumin excretion rate（ UAE） and glomerular filtration rate（ GFR） were measured. All patients were divided into the normal,low and high urinary protein groups for stratified analysis. Spearman＇s rank correlation analysis was performed to analyze the correlation among serum creatinine,Cys C and GFR. The receiver operating characteristic（ ROC） curve was obtained to statistically compare the diagnostic efficacy of Cys C,Scr and UAE in diabetic nephropathy [GFR 60 ml / min·（ 1. 73 m^2） ]. The influencing factors of Cys C were evaluated by multiple linear regression analysis. Results Age,course of diseases,GHb A1 c,Cys C,serum creatinine and 24 h UAE significantly differed among the normal,low and high urinary protein groups（ all P〈0. 05）. Serum creatinine was positively correlated with Cys C（ rs= 0. 862,P〈0. 001）,whereas Cys C and serum creatinine declined over the increases in GRF with negative correlation（ rs-Cys C=- 0. 816,rs-serum creatinine=- 0. 747,all P〈0. 001）. Cys C was more closely correlated with GRF compared with serum creatinine. The area under the ROC curve demonstrated that compared with serum creatinine,Cys C was higher efficacious in diagnosing nephropathy [GFR 60 ml / min·（ 1. 73 m^2） ]and had higher UAE（ 0. 963 vs. 0. 929 vs. 0. 720,all P〈0. 001）.The diagnostic cut-off point of Cys C was 1. 18 mg / L with sensitivity and specificity,93. 3% and 87. 9%. The diagnostic cut-off point of serum creatinine was 78. 9 μmol / L,with sensitivity and specificity 85. 6% and92. 6%. Multiple linear regression analysis revealed that the influencing factors of Cys C included blood uric acid,serum albumin,age and GHb A1 c,especially the blood uric acid with the highest influ

关 键 词：血清半胱氨酸蛋白酶抑制剂C 血清肌酐 2型糖尿病 肾小球滤过率 

分 类 号：R587.2[医药卫生—内分泌]