血清胱抑素C在2型糖尿病肾病早期诊断中的临床价值探讨

目的探讨血清胱抑素C在早期诊断2型糖尿病患者肾损伤的临床价值,同时分析血清胱抑素C与肾小球滤过率之间的关系。方法选择100例皖南地区2型糖尿病患者,根据所选患者24小时尿白蛋白排泄率,将患者分为正常白蛋白尿组（32例）、微量白蛋白尿组（39例）及大量白蛋白尿组（29例）。分别检测3组患者的血清胱抑素C、血尿素氮、血肌酐、肌酐清除率及肾小球滤过率等临床指标,同时对血清胱抑素C与肾小球滤过率的相关性进行统计学分析。结果在所选皖南地区2型糖尿病患者中,随着患者24小时尿白蛋白排泄量的增加,3组患者的肾小球滤过率及肌酐清除率均出现明显降低,血清胱抑素C水平出现升高,并与肾小球滤过率呈现明显的负相关性（P〈0.01）。而且血清胱抑素C、肾小球滤过率、肌酐清除率存在显著性差异;在单纯性2型糖尿病患者中,血肌酐及血尿素氮的检出率均较低,但肾小球滤过率不同的患者,胱抑素C水平却有明显差别,eGFR〈60 ml/（min·1.73 m^2）患者的血清CysC水平明显高于eGFR≥60 ml/（min·1.73 m^2）的患者,且该差异具有统计学意义。结论血清胱抑素C是一种能灵敏反映肾小球滤过率的内源标记物,其不仅与肾小球滤过率呈现良好的临床相关性,而且能反映2型糖尿病患者的不同肾损伤程度,进而用于单纯性2型糖尿病患者肾小球滤过率下降的早期诊断。

Clinical value of serum cystatin C in early diagnosis of diabetic nephropathy in type 2 diabetes

Objective To discuss the clinical value of serum cystatin C（ CysC） in the early diagnosis of renal impairment in patients with type 2 diabetes,and analyze the relationship between serum CysC level and glomerular filtration rate（ eGFR）. Methods According to 24 h urines albumin excretion rate,100 type 2 diabetic patients in southern Anhui areas were divided into non-albuminuria group（ n = 32）,microalbuminuria group（ n = 39） and macroalbuminuria group（ n =29）. The levels of serum CysC,blood urea nitrogen（ BUN）,serum creatinine（ Scr）,creatinine clearance rate（ Ccr） and eGFR of the three groups were tested. The correlation between eGFR and serum Cys C was also analyzed statistically. Results Among the three groups,both eGFR and Ccr declined with the increasing of 24 h urines albumin excretion rate,but the CysC level increased and presented a negative correlation with eGFR（ P 〈0. 01）. There was also a significant difference in serum CysC,eGFR and Ccr among the three groups. The detection rates of Scr and UBN were low for type 2 diabetic patients with non-albuminuria,but there was obvious difference of CysC for the patients with different eGFR. The CysC level of the patients with eGFR 60 ml /（ min·1. 73 m^2） was apparently higher than that of the patients with eGFR≥60 ml /（ min·1. 73 m^2）,and this difference was statistical significance. Conclusion The serum CysC was a sensitive endogenesis marker of eGFR,it not only had a good clinical correlation with eGFR,but also showed the different degree of renal impairment for type 2 diabetic patients,and can early diagnose the decline of eGFR in type 2 diabetic patients with non-albuminuria.