血清胱抑素C在2型糖尿病不同肾损害期的变化及其临床意义

目的探讨血清胱抑素C在2型糖尿病不同肾损害期的变化及其临床意义,比较血清胱抑素C与肾小球滤过率、尿微量白蛋白排泄率间的相关性。方法采用颗粒增强散射免疫比浊法测定102例2型糖尿病患者(其中并糖尿病肾病66例)血清胱抑素水平,同时测定肾小球滤过率和尿微量白蛋白排泄率。结果2型糖尿病正常白蛋白尿组,2型糖尿病微量白蛋白尿组及2型糖尿病大量白蛋白尿组间血清胱抑素C水平均有显著差异(P<0.01),2型糖尿病微量白蛋白尿组和2型糖尿病大量白蛋白尿组血清胱抑素C测值与肾小球滤过率有良好的相关性(P<0.05)。结论血清胱抑素C在临床上可作为肾小球滤过率的判断指标,且有助于2型糖尿病肾病的早期诊断。     

The meaning of Cystatin C in early diabetic nephropathy diagnosis

目的 探讨血清胱抑素C在早糖尿病肾病患者肾功能评价中的诊断价值.方法 选取114例糖尿病患者,入院测定肾小球滤过率(GFR),根据GFR分为两组:A组47例,GFR≥90ml/min;B组67例,GFR＜ 90 ml/min.同时测定胱抑素C、肌酐、尿素氮、尿酸、空腹血糖、餐后2小时血糖、糖化血红蛋白(HbA1c)、尿微量蛋白等,比较两组胱抑素C水平,同时分析影响胱抑素C的因素.结果 两组间胱抑素C水平比较差异有统计学意义,相关分析显示胱抑素C除了与GFR、尿素氮、尿酸等密切相关外,与年龄、糖尿病病程、HbA1c也密切相关.结论 胱抑素C可以作为早期发现糖尿病患者的肾脏损害一个检测指标.     

血清胱抑素C在高血压早期肾损伤中的诊断价值

目的探讨血清胱抑素C（Cystain C）水平在原发性高血压早期肾损伤中的临床诊断价值。方法选择我院收治的高血压1～2级患者共78例作为观察组,同时选择79例健康体检者作为对照组,分别检测两组治疗前后Cystain C、24h尿清蛋白定量、血清肌酐（Scr）、内生肌酐清除率（Ccr）等。结果两组SBP、DBP、血清胱抑素C、24h尿清蛋白定量、内生肌酐清除率间差异有统计学意义（P〈0．01）,血清肌酐间差异无统计学意义（P〉0．05）。观察组中Cystain C与24h尿清蛋白定量、血清肌酐、内生肌酐清除率有较好的相关性,并且血清胱抑素C与尿清蛋白定量的相关性优于Scr、Ccr的相关性,并与尿清蛋白定量、血清肌酐方向一致。结论血清Cystain C的浓度比Scr浓度更能够反映肾小球滤过功能的损害,是早期诊断肾小球滤过功能受损的敏感指标。     

尿微量清蛋白及血清胱抑素C联合检测对评估高尿酸血症合并糖尿病肾损伤的研究

目的探讨尿微量清蛋白及血清胱抑素C联合检测对评估高尿酸血症合并糖尿病肾损伤的影响。方法选取2016年2月—2018年2月在该院接受治疗的高尿血症合并糖尿病患者共100例作为研究对象,其中尿蛋白定性结果为阳性的48例患者作为观察组,尿蛋白定性结果为阴性的52例患者作为对照组,对所有患者进行尿微量清蛋白、血清胱抑素C、尿素氮以及血肌酐水平进行监测,分析比较两组患者的各项指标的阳性率。结果尿蛋白定性结果为阳性的观察组患者的尿微量清蛋白水平、血清胱抑素C水平、血肌酐水平、尿素氮水平均要高于尿蛋白定性结果为阴性的对照组,而且,观察组患者的尿微量清蛋白阳性率、血清胱抑素C阳性率、2项联合阳性率、血肌酐阳性率、尿素氮阳性率都明显高于对照组,差异有统计学意义(P0.05)。结论联合应用尿微量清蛋白及血清胱抑素C对高尿血症合并糖尿病患者进行监测,其应用价值较高,可以有效提高诊断肾损伤的敏感性,值得在临床上进行推广使用。     

胱抑素C和同型半胱氨酸与糖尿病肾病的相关性研究

目的 探讨2型糖尿病(T2DM)患者血清胱抑素C(Cys C)和同型半胱氨酸(Hcy)水平对于诊断早期糖尿病肾损伤的临床意义.方法 比较单纯糖尿病组(SDM)、早期糖尿病肾病组(EDN)、临床糖尿病肾病组(CDN)与对照组(NGT)患者间血清Cys C、Hcy水平和24小时尿白蛋白排泄率(UAER),应用MDRD简化公式计算肾小球滤过率(GFR)并进行分析.结果 2型糖尿病患者EDN组及CDN组的Hcy、Cys C水平均高于SDM组及NGT组,差异有统计学意义(P＜0.05),Cys C、Hcy分别与UAER及血肌酐(Scr)呈正相关,与GFR呈负相关.结论 Cys C和Hcy是能够反映早期糖尿病肾损伤的标志物.     

血清胱抑素C在2型糖尿病肾病诊断中的应用

目的探讨血清胱抑素C(Cys-C)在2型糖尿病肾病诊断中的应用价值。方法选取昆明医科大学第一附属医院肾内科住院部2016年9月—2017年12月收治的2型糖尿病患者355例,其中按照尿白蛋白肌酐比值(ACR)不同,分为正常白蛋白尿组、微量白蛋白尿组、大量白蛋白尿组,分别检测3组患者血清胱抑素C(Cys-C)、尿素(Urea)、血肌酐(Scr)及肾小球滤过率(eGFR,以MDRD公式计算)。结果微量白蛋白尿组及大量白蛋白尿组Cys-C水平均明显高于正常白蛋白尿组(P<0.05)。糖尿病肾病组中Cys-C、Urea、Scr、eGFR阳性率分别为95%、71%、86%、96%,且Cys-C和eGFR检测阳性率结果明显高于Urea和Scr(P<0.05)。结论Cys-C更为准确地反映肾小球滤过功能,尤其在诊断糖尿病患者早期肾损伤中具有重要临床意义。     

糖尿病肾病诊断中胱抑素C和尿微量清蛋白检测的应用及意义探究

目的探讨糖尿病肾病诊断当中胱抑素C与尿微量清蛋白检测的临床价值。方法选2015年12月—2017年8月在该院进行就诊的疑似糖尿病肾病患者60例作为研究组,选同期糖尿病无肾病患者60例作为对照组。两组均进行胱抑素C与尿微量清蛋白含量检测,观察检测结果。结果研究组患者的血清胱抑素C、尿微量清蛋白水平要明显高于对照组,两组数据差异有统计意义(P0.05)。与手术结果进行比较,研究组患者糖尿病肾病检出57例,诊断符合率为95.0%(57/60),两者进行对比,差异无统计意义(P0.05)。结论胱抑素C与尿微量清蛋白含量检测糖尿病肾病的准确度较高,可以有效提高临床诊断准确率,具有重要的临床价值。     

胱抑素C对评价全面达标治疗糖尿病肾病疗效的意义

目的探讨胱抑素C(Cys C)对评价全面达标治疗糖尿病肾病疗效的意义。方法选取2010年8月—2012年3月苏州市立医院收治的糖尿病肾病患者56例,对其行强化短期全面达标治疗。记录患者达标情况,并观察所有患者Cys C、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)及糖化血红蛋白(HbA1c)、LDL-C、TG、血肌酐(Scr)、24 h尿微量清蛋白(24 h-MAlb)、尿酸(UA)水平。治疗3个月和6个月时,将FBG、血压、LDL-C、体质指数(BMI)、UA等指标达标患者35例作为观察组;上述1~4项指标达标患者21例作为对照组。结果治疗后,观察组SBP、UA、24 h-MAlb、Cys C水平低于对照组,肾小球滤过率(GFR)高于对照组(P0.05)。Pearson相关性分析显示Cys C降幅与SBP、HbA1c、LDL-C、24 h-MAlb、UA降幅呈正相关(r值分别为0.568、0.523、0.473、0.485、0.421,P0.05),与GFR降幅呈负相关(r=-0.679,P0.01)。结论 Cys C可以作为评价全面达标治疗糖尿病肾病疗效的内源性生物学指标。     

血清同型半胱氨酸和胱抑素C联合检测在2型糖尿病肾病早期诊断中的价值

目的探讨了血清胱抑素C(Cys C)和同型半胱氨酸(Hcy)联合检测在2型糖尿病肾病早期诊断中的价值。方法将2012年1月—2014年6月该院内分泌科住院的80例2型糖尿病患者按糖尿病肾病诊断标准分为55例糖尿病肾病组与25例糖尿病无肾损伤组,选择60名健康人作为正常对照组。同时检测3组患者的尿素氮、肌酐、Hcy、Cys C、尿微量清蛋白排泄率(UAER)和Hcy。结果糖尿病肾病(DN)组人群尿微量清蛋白排泄率(UAER)、尿素氮(BUN)、肌酐(CRe)、胱抑素C(Cys C)及同型半胱氨酸(Hcy)四项指标含量高于健康人群对照组和无肾脏损伤的尿病组(P0.05)。结论联合检测Hcy和Cys C水平对2型糖尿病(T2DM)患者肾功能早期损伤的诊断及治疗有非常重要的意义。     

2型糖尿病肾病患者血胱抑素C、尿白蛋白排泄与糖化血红蛋白关系的研究

观察2型糖尿病及糖尿病肾病患者的血清胱抑素C（Cys—C）、尿白蛋白与糖化血红蛋白（HbA1C）水平,并观察这些指标间的相关关系。结果微量蛋白尿组患者的HbA1C、Cys—C水平较单纯糖尿病组升高（P〈0．05）,而大量蛋白尿组患者较其他两组均有显著性差异（P〈0．05）,HbA1C与Cys-C、24h尿白蛋白水平均呈正相关关系。结论HbA1C水平可一定程度的预测Cys—C、24h尿白蛋白水平。     

血清胱抑素C及尿微量白蛋白对妊娠期糖尿病患者肾功能评价的临床意义

目的探讨血清胱抑素C（Cys C）、尿微量白蛋白（mALB）对妊娠糖尿病（GDM）患者肾损害的早期诊断价值。方法用免疫比浊法检测血清Cys C、mALB水平,用酶法检测血尿素氮（BUN）、肌酐（Scr）水平。结果 GDM组与对照组Cys C、尿mALB、Scr比较差异均有统计学意义（P〈0.05或〈0.01）;GDM组BUN水平高于对照组,但差异无统计学意义（P〉0.05）。结论联合检测Cys C、mALB对更好的早期诊断GDM肾病具有重要意义。     

糖尿病肾病并发下肢动脉病变的相关因素分析

目的探讨糖尿病肾病（DN）和糖尿病并发下肢动脉病变（PAD）的相关影响因素。方法选取,DN患者235例（DN组）,单纯糖尿病患者102例（DM组）,测定两组踝肱指数（ABI）及其他相关指标,研究下肢动脉病变发生情况及其影响因素。结果DN组下肢动脉病变发生率（63．0％）高于DM组（11．8％）,差别有统计学意义;DNPAD＋组、DNPAD-组、DMPAD＋组、DMPAD-组的年龄、SBP、DBP、LDL-C、FPG、肾小球滤过率（GFR）、纤维蛋白原（FBG）、UAlb／Cr、24h尿蛋白定量差别均具有统计学意义;DN组发生下肢动脉病变的可能影响因素是SBP、UAlb／Cr、GFR、24h尿蛋白定量;DM组发生下肢动脉病变的可能影响因素是SBP、DBP、24h尿蛋白定量。结论收缩压、纤维蛋白原和尿蛋白可能是DN患者并发下肢动脉病变的预警因子,应对其进行筛查,并给予积极的治疗,从而减少或延缓下肢血管病变的发生及发展。     

Neutrophil Gelatinase-Associated Lipocalin (NGAL): an early marker for diabetic nephropathy

Neutrophil gelatinase-associated lipoprotein (NGAL) represents a novel biomarker for early identification of acute kidney injury. This study evaluates the usefulness of urine NGAL as a marker for the early detection of diabetic nephropathy. This is a cross-sectional study which involved ninety patients with diabetes mellitus and thirty healthy controls. The diabetic patients were categorized into three groups based on their urine albumin/creatinine ratio (UACR); normoalbuminuria (<3.5?mg/mmol), microalbuminuria (3.5?C35?mg/mmol), macroalbuminuria (>35?mg/mmol). In addition to urine NGAL, HbA1C, serum creatinine, urine albumin/creatinine ratio, serum cystatin C, and urine protein were assessed to determine their correlation with urine NGAL. Data analysis was done by using SPSS and MiniTab. Urine NGAL was elevated in all groups of diabetic patients with respect to controls. It was increased proportionately to the severity of kidney function. It was also elevated in some normoalbuminuria diabetic patients. Analysis of correlation revealed that urine NGAL was not correlated with glycemic indices (HbA1C and fasting blood glucose). However, urine NGAL correlated significantly with cystatin C, serum creatinine, urine albumin/creatinine ratio, and inversely with eGFR. Besides, it is also shown to have a significant correlation with eGFR in advanced kidney disease (eGFR?<?30?ml/min per 1.73?min²). Urine NGAL can be used as a non-invasive tool for the early detection and assessment of the severity of diabetic nephropathy.     

2型糖尿病患者血清缺血修饰白蛋白与颈动脉内膜中层厚度的关系

目的探讨2型糖尿病患者血清缺血修饰白蛋白（IMA）与颈动脉内膜中层厚度（CIMT）的关系。方法依据CIMT将130例2型糖尿病患者分为非颈动脉粥样硬化（NCAS）组和颈动脉粥样硬化（CAS）组。比较2组缺血修饰白蛋白及代谢参数方面的差异,分析2型糖尿病患者CAS的危险因素。结果 CAS组糖尿病病程、HbA1c、IMA显著高于NCAS组,且IMA与HbA1c呈正相关;Logistic回归分析显示糖尿病病程、HbA1c、IMA为CAS的独立危险因素。结论 IMA可能用于预测2型糖尿病CAS发生和发展。     

Cystatin C predicts diabetic retinopathy in Chinese patients with type 2 diabetes

This study aims to identify the predictive value of cystatin C for diabetic retinopathy (DR) in Chinese patients with type 2 diabetes. Data from a cross-sectional hospital-based survey of 450 type 2 diabetes patients were analyzed in the study. DR was assessed by fundus fluorescein angiography. Duration of diabetes and other related information were obtained by questionnaire. Body mass index, blood pressure, HbA_1c, cystatin C, glomerular filtration rate, urinary albumin excretion, blood lipids, and uric acid were measured. Binary logistic regression was performed to evaluate potential risk factors for DR. The predictive value of cystatin C for DR was evaluated using ROC curve. Cystatin C (P = 0.039) was a risk factor for DR after GFR, and other possibly related variables were adjusted. Cystatin C had a significant predictive value for any DR (AUC, 0.763, P < 0.001; optimal cutoff value, 1.11 mg/L; sensitivity, 56.00 %; specificity, 83.90 %) or severe DR (AUC, 0.821, P < 0.001; optimal cutoff value, 1.23 mg/L; sensitivity, 73.60 %; specificity, 88.70 %). Cystatin C is a novel risk factor for DR and should be used to screen and forecast the presence of DR (especially severe DR) in Chinese patients with type 2 diabetes. The association between cystiatin C and DR should not depend on the excellent ability of cystatin C for the estimation of GFR.

     

The role of vascular endothelial growth factor, tumor necrosis factor alpha and interleukin-6 in pathogenesis of diabetic retinopathy

The aim of the study was to analyze the relation between early diabetic retinopathy and the pro-inflammatory cytokines tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), vascular endothelial growth factor (VEGF) in children with diabetes mellitus type 1. Two hundred and two children with diabetes mellitus type 1 aged 13.2+/-3.83 years and 85 healthy controls were analyzed. Patients were divided into two subgroups: children with retinopathy (Group 1, n=39) and children without retinopathy (Group 2, n=163). All the children had 24h urine albumin secretion rate, glycosylated hemoglobin HbA1c level, and C-reactive protein level measured, underwent 24h blood pressure monitoring and had ophthalmologic examination performed. Additionally, all the children had serum TNF-alpha, IL-6 and VEGF level measured using an ELISA test (Quantikine High Sensitivity Human). Statistically significant higher blood serum levels of HbA1c, VEGF, TNF-alpha and IL-6 were found in the Group 1 in comparison with the Group 2. Additionally, the children of the Group 1 showed statistically significant correlation between serum VEGF and serum TNF-alpha (R=0.35, p=0.000), CRP level (R=0.23, p=0.006), 24h albumin urine secretion rate (R=0.45, p=0.000) and duration of the disease (R=0.26, p=0.002). The results of the current study suggest that there is a relationship between VEGF, TNF-alpha, IL-6 and the development of the diabetic retinopathy in children with diabetes mellitus type 1.     

Results from the Effects of MEtformin on cardiovasculaR function in AdoLescents with type 1 Diabetes (EMERALD) study: A brief report of kidney and inflammatory outcomes

Youth with type 1 diabetes (T1D) demonstrate insulin resistance, independently of glycaemia, when compared to normoglycaemic peers. Insulin resistance increases the risk of cardiovascular disease and diabetic kidney disease, factors also associated with systemic inflammation. We evaluated the effect of metformin on markers of inflammation and diabetic kidney disease in adolescents with T1D. EMERALD, a double-blind, randomized, placebo-controlled trial of 3 months of metformin in 48 participants aged 12–21 years with T1D, included baseline and follow-up assessments of serum creatinine and cystatin C to estimate glomerular filtration rate (eGFR), aspartate aminotransferase, alanine aminotransferase, high-sensitivity C-reactive protein, white blood count, platelets, adiponectin, leptin, and urine albumin: creatinine ratio (UACR). Metformin was associated with a 13.9 mL/min/1.73 m² (95% confidence interval 4.7–23.1 mL/min/1.73 m²) increase in estimated GFR by serum creatinine versus placebo (P ≤ 0.01), with a significant difference remaining after multivariable adjustments (P = 0.03). Whereas eGFR measured by serum creatinine increased significantly after metformin treatment, no differences were observed in cystatin C, UACR, or systemic inflammatory markers. Additional studies with directly measured GFR in response to metformin in T1D are needed.     

New and old markers of progression of diabetic nephropathy

The onset of diabetic nephropathy is characterised by a rise in albumin excretion rate (AER) and/or a transient rise in glomerular filtration rate (GFR) (hyperfiltration). Without intervention AER increases exponentially and there is a linear decrease in GFR after onset of overt nephropathy. In overt nephropathy, AER is a predictor of decline in GFR and the early AER response to antihypertensive therapy correlates with long-term decline in GFR. AER can be measured by immunoassay or by other techniques including HPLC. However, HPLC assays result in higher levels of AER in normal subjects compared with immunoassayable AER. Recent data suggest that there are distinct albuminuric and non-albuminuric pathways to renal impairment in type 1 and type 2 diabetes. In type 2 diabetes, the non-albuminuric pathway may explain a decline in GFR to <60 ml/min/1.73 m(2) in approximately one in four subjects after accounting for the use of renin angiotensin system inhibitors. In established nephropathy (chronic kidney disease (CKD) stages 3 and 4), plasma cystatin C based estimates of GFR are marginally superior to creatinine based estimates. However, cystatin C clearly outperforms creatinine based estimates of GFR decline at GFR levels >60 ml/min/1.73 m(2) (CKD stages 1 and 2). Other potential markers of progression of diabetic nephropathy include transforming growth factor beta (TGFbeta) and connective tissue growth factor (CTGF). However, long-term studies are needed to define their roles as markers of progression. Diabetic nephropathy is likely to be more susceptible to intervention at an early stage and accurate estimation of GFR is already possible with cystatin C. However, improved formulas for estimating GFR based on using creatinine or other markers are still required, because this may still provide the most cost effective approach applicable to existing clinical practice.     

Beta2-microglobulin and cystatin C in type 2 diabetes: assessment of diabetic nephropathy.

BACKGROUND: Changes in glomerular filtration rate (GFR) provide a valuable indicator of the progression of diabetic nephropathy (DN). This study was designed to demonstrate the clinical values of serum cystatin C (Cys C) and beta2-microglobulin in the assessment of renal function in type 2 diabetics by comparing them with the GFR, estimated from the uptake phase of 99 m technetium dimetiltriamino pentaacetic acid renogram (GFR-DTPA) and creatinine clearances. MATERIALS AND METHODS: 68 type 2 diabetic patients with (urinary albumin excretions (UAE) 30 - 300 mg/24 h) (n = 39) and without (UAE < 30 mg/24 h) (n = 29) microalbuminuria and 32 controls were enrolled in the study. Serum Cys C, beta2-microglobulin, creatinine, urinary microalbumin levels, creatinine clearances and GFR-DTPA values were determined in all groups. Non-parametric ROC curves, using a cut-off GFR-DTPA of 60 mL/min/1.73 m (2), were obtained for these markers. RESULTS: Serum Cys C, beta2-microglobulin, glucose and HbA1c concentrations were significantly higher in the group with diabetes compared to controls. In the patients with microalbuminuria, serum Cys C and glucose concentrations increased significantly in comparison to patients with normoalbuminuria, while no differences were observed for beta2-microglobulin levels. Serum creatinine concentrations, GFR-DTPA values and creatinine clearances were not different between both diabetic groups and controls. Cys C was positively correlated with beta2-microglobulin and creatinine and negatively with GFR values; beta2-microglobulin was also positively correlated with serum creatinine in microalbuminurics. A significant inverse correlation was found between beta2-microglobulin and GFR values in both microalbuminurics and normoalbuminurics. CONCLUSIONS: Increased Cys C and beta2-microglobulin in diabetics may be early indicators of incipient DN. The diagnostic accuracies of Cys C and beta2-microglobulin are superior to that of serum creatinine in distinguishing between mild and moderately reduced GFR.     

2型糖尿病合并脑梗塞与血脂、血压分析

分析2型糖尿病合并脑梗塞与血脂、血压异常的关系.收集我院2型糖尿病患者100例,其中合并脑梗塞者60例,正常对照组40例.分别测定血脂、血压并进行比较.结果糖尿病合并脑梗塞组血甘油三酯、载脂蛋白B、收缩压明显升高,高密度脂蛋白、载脂蛋白A1显著降低.血甘油三酯、收缩压升高、高密度脂蛋白降低是糖尿病并发脑梗塞的危险因素.