血清胱抑素C对糖尿病肾病临床分期的价值

目的 探讨胱抑素C(Cys-C)作为2型糖尿病(T2DM)肾病分期指标的应用价值.方法 测定137例T2DM患者血肌酐(SCr)、Cys-C和24-h尿微量白蛋白排泄率(UAER).运用MDRD公式计算肾小球滤过率(GFR).将患者分为三组:GFR>120 ml·min~(-1)·1.73 m~(-2)为A组,GFR 60～120 m1·min~(-1)·1.73 m~(-2)为B组,GFR<60 ml·min~(-1)·1.73m~(-2)为C组.绘制散点图,比较三组Cys-C和UAER的数值及与GFR的相关性.结果 C组SCr和24-hUAER高于A组[(102.41±10.72)μmol/L vs.(42.73±3.99)μmol/L和(303.90±173.66)mg vs.(164.10±114.25)mg];A组Cys-C值明显低于B、C组[(0.47±0.21)mg/L vs.(o.68±0.13)mg/L,(1.59±0.58)mg/L)].UAER和Cys-C与GFR的相关系数分别为-0.132和-0.552(P<0.01).ROC分析提示,Cys-C和UAER的曲线下面积(AUC)分别为0.885和0.605(P<0.05).结论 Cys-C能很好的反映T2DM肾病肾小球滤过功能异常,与临床分期的对应性、诊断特异性和灵敏性都优于UAER.

Clinical value of cystatin C in staging diabetic nephropathy

Objective To evaluate the clinical usefulness of serum cystatin C(Cys-C)in staging diabetic nephropathy. Methods Serum creatinine (SCr), Cys-C and urine albumin excretion rate (UAER) were detected in 137 patients with type 2 diabetes(T2DM). Glomelular filtration rate(GFR) was calculated with MDRD-GFR fomula,based on which the patients were divided into three groups of A(120ml·min~(-1)· 1. 73 m~(-2)) ,B(60-120 ml · min~(-1) · 1.73 m~(-2)) and C (<60 ml · min~(-1) · 1. 73 m~(-2)). Correlation between Cys-C and UAER with GFR was analyzed. Results Cys-C and UAER were significantly higher in group C than those in group A [(102. 41 ± 10. 72) mol/L vs. (42. 73± 3. 99) mol/L and (303. 9±173. 66) mg vs. (164.1 ± 114. 25) mg]. Cys-C was lower in group A than that in groups of B and C [(0. 47±0. 21) mg/L vs. (0. 68±0. 13) mg/L and (1. 59±0. 58) mg/L]. The correlation coefficient was -0.132 for UAER and GFR and -0. 552 for Cys-C and UAER (P< 0. 01). Receiver operating characteristic curve(ROC) analysis showed the AUC of 0. 885 for Cys-C and 0. 605 for UAER Conclusion The results indicate that Cys-C would be a good marker for the assessment of diabetic nephropathy in T2DM.