血清胱抑素C对增殖性糖尿病视网膜病变患者肾功能损害的评估价值  

The value of serum cystatin C for the evaluation of renal function damage in patients with proliferative diabetic retinopathy

作　　者：白静[1] 张梅[2] 曹绪胜 曹晶晶[4] Bai Jing;Zhang Mei;Cao Xusheng;Cao Jingjing(Department of Comprehensive Internal Medicine,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Nephrology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Ophthalmology,Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Ophthalmology and Visual Science Key Lab,Beijing 100730,China;Department of Laboratory Medicine,Beijing Tongren hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院综合内科,北京100730 [2]首都医科大学附属北京同仁医院肾内科,北京100730 [3]首都医科大学附属北京同仁医院,北京同仁眼科中心,眼科学与视觉科学北京市重点实验室,北京100730 [4]首都医科大学附属北京同仁医院检验科,北京100730

出　　处：《中华医学杂志》2021年第30期2400-2404,共5页National Medical Journal of China

摘　　要：目的探讨血清胱抑素C(CysC)水平在增殖性糖尿病视网膜病变(PDR)患者发生肾功能损害中的评估价值。方法收集2019年7月至2021年1月在北京同仁医院眼底科接受治疗的PDR患者临床资料,以简化肾脏病膳食改良试验(MDRD)公式估算肾小球滤过率(eGFR)。以eGFR是否≥60 ml·min^(-1)·(1.73m^(2))^(-1),将患者分为肾功能无明显受损组和肾功能不全组。比较两组患者的临床资料,对PDR患者合并肾功能不全的相关因素进行多因素logistic回归分析。应用ROC曲线评估血清CysC对PDR患者发生肾功能不全的评估价值。结果共纳入1009例PDR患者,男593例,女416例,年龄(52±12)岁;肾功能不全组192例(19.0%),肾功能无明显受损组817例(81.0%)。两组患者性别、年龄、舒张压、体质指数、空腹血糖、低密度脂蛋白差异均无统计学意义(均P>0.05);肾功能不全组收缩压、血尿素氮、血肌酐、血尿酸、三酰甘油、总胆固醇、CysC均高于肾功能无明显受损组(均P<0.05),糖化血红蛋白、血白蛋白、高密度脂蛋白均低于肾功能无明显受损组(均P<0.05)。多因素logistic回归分析结果显示血肌酐(OR=1.189,95%CI:1.101~1.284,P<0.001)、CysC(OR=3.175,95%CI:1.272~7.923,P=0.013)是PDR患者合并肾功能不全的独立相关因素。血清CysC水平预测肾功能不全的ROC曲线下面积为0.966(95%CI:0.952~0.979),最佳临界值为1.315 mg/L,约登指数0.826,灵敏度94.3%,特异度88.4%。结论血清CysC是监测PDR患者发生肾功能不全的重要指标。Objective To investigate the value of serum cystatin C for the evaluation of renal function damage in patients with proliferative diabetic retinopathy(PDR).Methods The clinical data of PDR patients treated in ophthalmic wards of Beijing Tongren Hospital from July 2019 to January 2021 were retrospectively analyzed.The estimated glomerular filtration rate(eGFR)was calculated by the abbreviated Modification of Diet in Renal Disease(MDRD)study equation.Based on the eGFR level,the patients were divided into no obvious renal function damage group[≥60 ml·min^(-1)·(1.73m^(2))^(-1)]and renal inadequacy group[<60 ml·min^(-1)·(1.73m^(2))^(-1)].The clinical characteristics between the two groups were compared.Multivariate logistic regression analysis was performed to identify the relevant factors of renal inadequacy.The value of cystatin C to predict the renal inadequacy was calculated by the receiver operating characteristic(ROC)curves.Results A total of 1009 patients[593 males and 416 females;mean age:(52±12)years]were finally included in the study,with 192 cases(19.0%)and 817 cases(81.0%)in renal inadequacy group and no obvious renal function damage group,respectively.There were no significant statistically differences in gender,age,diastolic blood pressure,body mass index,fasting blood glucose and low-density lipoprotein between the two groups(all P>0.05).The systolic blood pressure,blood urea nitrogen,creatinine,uric acid,triglyceride,cholesterol and cystatin C were higher in the renal inadequacy group than those of no obvious renal function damage group(all P<0.05).However,the glycosylated hemoglobin,albumin and high-density lipoprotein were lower in the renal inadequacy group(all P<0.05).Multivariate logistic regression analysis showed that serum creatinine(OR=1.189,95%CI:1.101-1.284,P<0.001)and cystatin C(OR=3.175,95%CI:1.272-7.923,P=0.013)were independent risk factors for renal inadequacy in PDR patients.The ROC curve showed that cystatin C had a predictive value for renal inadequacy,with an area under the cu

关 键 词：糖尿病肾病 糖尿病视网膜病变 半胱氨酸蛋白酶抑制剂C 

分 类 号：R587.2[医药卫生—内分泌] R774.1[医药卫生—内科学] R692.9[医药卫生—临床医学]