血清同型半胱氨酸、胱抑素C、胆红素水平与2型糖尿病伴慢性肾脏病的相关性探讨  

The correlation between serum homocysteine,Cystatin C,bilirubin level and chronic kidney disease in patients with type 2 diabetes mellitus

作　　者：刘晓倩 傅莉萍[2] 王保法[2] 金剑虹[2] Liu Xiaoqian

机构地区：[1]杭州市丁桥医院,310044 [2]杭州市中医院,310005

出　　处：《浙江临床医学》2022年第8期1133-1135,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省医药卫生科技计划项目(2020KY226)。

摘　　要：目的 探讨2型糖尿病患者血清同型半胱氨酸(Hcy)、胱抑素C(Cys-c)及血清胆红素与慢性肾脏病(CKD)的相关性及临床意义.方法 选取2018年9月至2021年9月在杭州市中医院内分泌科收治的2型糖尿病患者242例,检测患者的理化指标.根据尿白蛋白/肌酐比值(UACR)将入选患者分为正常蛋白尿组(NA)、微量蛋白尿组(MA)和大量蛋白尿组(OA),采用Pearson相关分析、非条件logistic回归模型、ROC曲线分析进行统计分析.结果 总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)与CKD呈负相关(P<0.05),是CKD的保护因素(P<0.01);Hcy、Cys-c、糖化血红蛋白(HbA1c)与CKD呈正相关(P<0.05),是CKD的独立危险因素(P<0.01).ROC曲线面积由高到低排序依次为TBIL>Cys-c>Hcy>DBIL>IBIL.当5项联合检测时敏感度为96.4%,特异度为92.1%,显著高于单项检测结果(P<0.05).结论 血清Hcy、Cys-c、TBIL、DBIL、IBIL是2型糖尿病合并CKD患者病程进展中的重要生物学指标,可用于CKD的早期预测,且5项联合检测时其诊断效能显著提高.Objective To investigate the correlation and clinical significance between serum homocysteine(Hey),Cystatin C(Cys-c),bilirubin level and chronic kidney disease(CKD)in patients with type 2 diabetes melitus.Methods 242 patients with type 2 diabetes melitus admited to our department from September 2018 to September 2021 were selected as research subjects.The physical and chemical indexes were detected.According to Urinary albumin/creatinine ratio(UACR),the selected patients were divided into normal proteinuria group(NA),microalbuminuria group(MA)and hyperalbuminuria group(OA).Pearson correlation analysis,non-conditional logistic regression model and ROC curve analysis were used for statistical analysis.Results total ilinubin(TBIL),direct bilinubin(DBIL)and indirectbilinubin(IBIL)were negatively correlated with CKD(P<0.05),TBIL,DBIL and IBIL were the protective factors of CKD(P<0.01);Hey,Cys-C and glycosylated hemoglobin(HbAlc.)were positively corelated with CKD(P<0.05),Hey,Cys-C and HbAlc were independent risk factors for CKD(P<0.01).The order of ROC curve area from high to low is TBIL>Cys-C>Hcy>DBIL>IBIL.The sensitivity and specificity of joint detection of Hcy,Cys-C,TBIL,DBIL and IBIL were 96.4%and 92.1%,which were significantly higher than those of single detection(P<0.05).Conclusion Serum Hey,Cys-C,TBIL,DBIL and IBIL are important biological indexes in the progression of CKD,which can be used for the early prediction of CKD,and the diagnostic eficiency ofjoint detection of Hey,Cys-C,TBIL,DBIL and IBIL is significantly improved.

关 键 词：慢性肾脏病 2型糖尿病 同型半胱氨酸 胱抑素C 胆红素 

分 类 号：R587.2[医药卫生—内分泌] R692[医药卫生—内科学]