血清CysC、RBP、NEFA联合检测在2型糖尿病肾病早期诊断中的临床价值

目的探讨血清胱抑素C(Cys C)、视黄醇结合蛋白(RBP)、游离脂肪酸(NEFA)检测在2型糖尿病肾病(DN)中的临床价值。方法选取在本院确诊的2型糖尿病患者102例,健康体检者38例。糖尿病组按尿白蛋白分为3组:正常白蛋白尿组、微量白蛋白尿组、临床白蛋白尿组,分析其血清Cys C、RBP、NEFA、血清肌酐(Scr)、尿素氮(BUN)水平,并对结果进行比较分析。结果 2型糖尿病肾病患者血清中Cys C、RBP、NEFA的水平显著高于正常对照组(P0.05),而Scr、BUN两组间比较差异无统计学意义(P0.05)。正常白蛋白尿组、微量白蛋白尿组、临床白蛋白尿组Cys C、RBP、NEFA 3项联合检测的阳性率分别为18.6%、75.0%、100.0%,均高于各单项指标的检测阳性率。结论 2型糖尿病肾病患者中血清Cys C、RBP、NEFA升高明显,联合检测可作为2型糖尿病肾病的早期监控和病变的评估指标。     

尿微量白蛋白/肌酐比值、胱抑素C联合检测在糖尿病肾病早期诊断中的价值探讨

目的探讨尿微量白蛋白/肌酐比值、胱抑素C联合检测在糖尿病肾病早期诊断中的价值。第5卷第12期方法测定218例II型糖尿病患者和203例健康体检者的尿微量白蛋白/肌酐比值和血清胱抑素C水平,并进行比较。结果糖尿病患者的尿微量白蛋白/肌酐比值、胱抑素C明显高于健康体检者,P0.01,差异有统计学意义。结论尿微量白蛋白/肌酐比值、胱抑素C的水平可作为反映糖尿病患者早期肾脏损伤的一个灵敏指标。     

尿微量白蛋白与血清胱抑素C的联合测定在糖尿病肾病早期诊断中的临床意义

目的:探讨尿微量白蛋白与血清胱抑素C的联合测定对糖尿病肾病(DN)早期诊断的临床意义。方法:选择Ⅱ型糖尿病患者85例,健康对照组43例,分别检测尿微量白蛋白排泄率(UAER)和胱抑素C含量。结果:Ⅱ型糖尿病组的尿微量白蛋白排泄率,血清胱抑素C水平明显高于健康对照组差异有统计学意义(P0.01),并且血清胱抑素C水平随着Ⅱ型糖尿病患者尿微量白蛋白排泄率的增加而增加。结论:尿微量白蛋白与血清胱抑素C水平可作为DM患者早期肾损伤一个理想的反映肾小球滤过功能的敏感指标。     

血清胱抑素C对2型糖尿病患者早期肾损害预测作用的研究

目的评价血清胱抑素C（CysC）对2型糖尿病患者早期肾损害的预测价值。方法将87例2型糖尿病患者分为隐性糖尿病肾病组和显性糖尿病肾病组,健康体检者40例为对照组。检测血清CysC、尿素氮（BUN）、肌酐（SCr）及尿微量白蛋白（MA）,按MDRD公式计算GFR。结果与对照组相比,隐性糖尿病肾病组和显性糖尿病肾病组CysC、MA值均增高（P〈0.05）,且显性糖尿病肾病组CysC、MA值较隐性糖尿病肾病组更高（P〈0.05）。三组中CysC异常率最高。CysC与MA在隐性糖尿病肾病组中呈正相关,在显性糖尿病肾病组中无相关性。结论血清CysC能较好反映糖尿病患者早期肾损害。     

胱抑素C在糖尿病肾病早期诊断中的应用

目的:探讨血清胱抑素C在糖尿病肾病早期诊断中的应用。方法:选择40例确诊为2型糖尿病的患者,根据24h尿微量白蛋白排泄率(UAER)将其分为两组,其中UAER<30mg/24h的为单纯糖尿病组,30～300mg/24h的为糖尿病肾病早期组,20例健康体检者作为对照组研究。分别测定其胱抑素C、血肌酐、尿素氮等指标,并对其进行相关性分析。结果:T2DM患者单纯糖尿病组、糖尿病肾病早期组与对照组比较胱抑素C水平均有显著性差异(P<0.05),糖尿病肾病早期组较单纯糖尿病组的胱抑素C水平显著增高(P<0.05),且与UAER有良好的正相关性。糖尿病肾病早期组与单纯糖尿病组的BUN、CREA之间无显著性差异(P>0.05)。结论:血清胱抑素C随肾功能损坏程度加重而逐渐升高,其敏感度高于血CREA、BUN,可以作为糖尿病肾病早期的诊断指标,值得临床推广。     

血清CysC、β2-MG、尿微量白蛋白/尿肌酐比值与糖尿病肾病患者尿蛋白的相关性

目的探讨血清胱抑素C(CysC)、β2-微球蛋白(β2-MG)、尿微量白蛋白/尿肌酐比值与糖尿病肾病患者尿蛋白的相关性。方法选取2018年3月至2019年5月在本院门诊或住院部就诊的2型糖尿病患者216例,根据24 h尿微量白蛋白排泄率分为Ⅰ期组104例、Ⅱ期组70例、Ⅲ期组42例;选取同期健康志愿者100例为对照组。检测晨尿样本中的微量白蛋白、尿肌酐及24 h尿样本中尿微量白蛋白水平,根据尿量计算排泄率;检测血清CysC、β2-MG水平。结果Ⅰ期组、Ⅱ期组、Ⅲ期组患者血清CysC、β2-MG、尿微量白蛋白/尿肌酐比值明显高于对照组,Ⅱ期组、Ⅲ期组明显高于Ⅰ期组,Ⅲ期组明显高于Ⅱ期组,上述差异均有统计学意义(均P<0.05)。Ⅱ期组、Ⅲ期组患者尿微量白蛋白排泄率明显高于Ⅰ期组和对照组,差异均有统计学意义(均P<0.01);Ⅲ期组患者尿微量白蛋白排泄率(819.62±74.39)mg/24 h明显高于Ⅱ期组(153.05±41.39)mg/24 h,差异有统计学意义(P<0.01)。血清CysC、β2-MG、尿微量白蛋白/尿肌酐与尿微量白蛋白排泄率均呈正相关(均P<0.05)。结论随着糖尿病肾病患者尿蛋白程度进展,血清CysC、β2-MG、尿微量白蛋白/尿肌酐比值均升高。     

eGFR-MDRD和Cys C糖尿病肾病患者早期诊断的 价值分析

摘要:目的　探讨血清胱抑素C（Cystatin C,Cys C）与利用Cys C估算的eGFR-cys对于早期诊断糖尿病肾病的临床应用价值。方法　根据尿白蛋白排泄率将126例2型糖尿病患者分为单纯糖尿病组和糖尿病肾病组,对其空腹血糖（FBG）、餐后2 h血糖（2hPBG）、糖化血红蛋白（HbA1c）、24 h尿蛋白定量（24 h UPQ）、血肌酐（Scr）、尿素氮（BUN）、血清胱抑素C（Cys C）进行检测,根据简化的MDRD方程估算肾小球滤过率（eGFR）,使用CHINAcys方程估算eGFR（eGFR-cys）。使用受试者工作特征曲线（Receiver Operator Characteristic curve,ROC）分析各项指标的诊断价值。结果　与单纯糖尿病组相比,糖尿病肾病组的24 h UPQ、BUN、Scr、Cys C显著升高,eGFR-MDRD、eGFR-cys显著降低,差异有统计学意义（P＜0.01）。Cys C及eGFR-cys与24 h UPQ、Bun、Scr及eGFR-MDRD均有一定的相关性,Cys C与eGFR-MDRD相关性最大,相关系数为-0.681;4 h UPQ、Cys C与eGFR-cys的AUC＞0.75,这3项指标诊断DN的效能优于BUN、Scr与eGFR-MDRD。当以eGFR-cys＜60［ml·min-1（173m2）-1］,Cys C＞0.98 mg/L为截点时,eGFR-MDRD+Cys C联合诊断DN的敏感度和约登指数分别为87.35%与0.710,均高于BUN、Cys C、Scr、eGFR-MDRD。结论　eGFR-MDRD、Cys C 2项指标联合筛查发现真正的DN患者与单纯糖尿病患者的效果好,真实性大且敏感性强。     

糖尿病肾病患者血清C反应蛋白的变化及意义

目的探讨血清C反应蛋白（CRP）在糖尿病肾病不同时期的变化及临床意义。方法根据24h尿白蛋白（MAU）定量将102例2型糖尿病患者分为正常白蛋白尿组（A组,38例）,微量白蛋白尿组（B组,34例）和临床白蛋白尿组（C组,30例）,另选30例健康人群作为正常对照组。结果三组糖尿病患者的血清CRP水平明显高于正常对照组,差异有显著性（P〈0．05）,且CRP水平随尿白蛋白、血肌酐的增加而升高（P〈0．05）。结论2型糖尿病患者血清cRP水平随着糖尿病肾病的进展而逐渐增高,对糖尿病肾病的发生、发展及早期预测具有重要意义。     

糖尿病肾病患者血清胱抑素C和β2-微球蛋白及尿微量白蛋白/尿肌酐比值与尿蛋白的相关性

目的 研究糖尿病肾病(DN)患者血清胱抑素C( CysC)、β2-微球蛋白(β2-MG)和尿微量白蛋白/尿肌酐比值(UmAlb/UCr)与尿蛋白程度的相关性,为DN的临床诊治提供依据.方法 参照目前糖尿病合并DN公认的诊断指标,收集处于Ⅰ期正常白蛋白尿期24h尿微量白蛋白排泄率(UAE)＜30 mg/24 h]、Ⅱ期微量白蛋白尿期(30 mg/24 h≤UAE＜300 mg/24 h)和Ⅲ期大量白蛋白尿期(UAE＞300 mg/24 h)的糖尿病患者各52例(A组),35例(B组)和21例(C组),健康对照组50例.检测研究对象血清CysC、β2-MG水平和UmAlb/UCr.结果 与健康对照组比较,A组血清CysC、β2-MG水平升高,B、C组各检测指标均升高,差异均有统计学意义(P＜0.01).A、B、C组间比较,各检测指标差异均有统计学意义(P＜0.01),且随着临床分期的发展,血清CysC、β2-MG水平和UmAIb/UCr均上升.血清CysC、β2-MG和UmAlb/UCr与UAE的Pearson相关系数分别为0.486,0.536和0.858,均有统计学意义(P＜0.01).结论 糖尿病肾病患者血清CysC、β2-MG和UmAlb/UCr与蛋白尿分期密切相关,随着尿蛋白程度的发展,血清CysC、β2-MG水平和UmAlb/UCr均升高.     

2型糖尿病早期肾损害患者血清胱抑素C与尿微量白蛋白/肌酐比值的检查意义

[目的]探讨血清胱抑素C与尿微量白蛋白/肌酐比值对诊断2型糖尿病早期肾损害患者的临床诊断价值。[方法]选取2009年5月～2010年10月于某院内分泌科住院治疗的2型糖尿病尿蛋白定性试验为阴性患者60例为观察组,选择体检健康人60例作为对照组,分别对两组患者血清胱抑素C与尿微量白蛋白/肌酐比值进行检测,将检测结果进行统计分析。[结果]观察组患者Cys-C与mAlb/Cr检测结果分别为(0.95±0.24)mg/L、(0.75±0.42)mg/mmol,较对照组(1.62±0.34)mg/L、(12.42±10.37)mg/mmol,差异有统计学意义,P﹤0.05。[结论]Cys-C联合mAlb/Cr检测能提高对T2DM早期肾损害诊断的敏感性,具有较高临床意义,值得推广。     

2型糖尿病患者慢性肾脏病和蛋白尿的相关性分析

目的:探讨2型糖尿病(DM2)患者中1、2级慢性肾脏病(CKD1、CKD2)和蛋白尿的相关性。方法:对591例(男性:438例;女性:153例)DM2人群进行和断面调查。采用简化MDRD公式估算肾小球滤过率(eGFR)划分CKD1和CKD2。通过随机尿中白蛋白与肌酐比值(ACR,mg/g)确定蛋白尿。结果:CKD1组无蛋白尿、微量蛋白尿、大量蛋白尿的发生率分别为78.9%、18.1%和3.0%,CKD2组分别为63.4%、24.8%和11.8%。控制年龄、性别、糖尿病病程、体重指数、血压、血脂、空腹血糖和糖化血红蛋白,Logistic回归分析显示,微量蛋白尿较无蛋白尿的糖尿病患者发生CKD2危险性的OR(95%CI)值是3.06(1.19-7.84)倍;大量蛋白尿较无蛋白尿的糖尿病患者发生CKD2危险性的OR值是6.00(2.43-14.78)倍。结论:蛋白尿与CKD的发展联系紧密,是CKD1发展为CKD2的独立危险因素。     

Differences in urine cadmium associations with kidney outcomes based on serum creatinine and cystatin C

Cadmium is a well-known nephrotoxicant; chronic exposure increases risk for chronic kidney disease. Recently, however, associations between urine cadmium and higher creatinine-based estimated glomerular filtration rate (eGFR) have been reported. Analyses utilizing alternate biomarkers of kidney function allow evaluation of potential mechanisms for these observations. We compared associations of urine cadmium with kidney function measures based on serum cystatin C to those with serum creatinine in 712 lead workers. Mean (standard deviation) molybdenum-corrected urine cadmium, Modification of Diet in Renal Disease (MDRD) eGFR and multi-variable cystatin C eGFR were 1.02 (0.65) μg/g creatinine, and 97.4 (19.2) and 112.0 (17.7) mL/min/1.73 m², respectively. The eGFR measures were moderately correlated (r_s=0.5; p<0.001). After adjustment, ln (urine cadmium) was not associated with serum cystatin-C-based measures. However, higher ln (urine cadmium) was associated with higher creatinine-based eGFRs including the MDRD and an equation incorporating serum cystatin C and creatinine (beta-coefficient=4.1 mL/min/1.73 m²; 95% confidence interval=1.6, 6.6). Urine creatinine was associated with serum creatinine-based but not cystatin-C-based eGFRs. These results support a biomarker-specific, rather than a kidney function, effect underlying the associations observed between higher urine cadmium and creatinine-based kidney function measures. Given the routine use of serum and urine creatinine in kidney and biomarker research, additional research to elucidate the mechanism(s) for these associations is essential.     

Assessment of renal function according to the NHG protocol 'Diabetes mellitus type 2': risk of overestimating the number of diabetes patients with renal dysfunction

OBJECTIVE: To evaluate the consequences of the new Dutch College of General Practitioners (NHG) protocol 'Diabetes mellitus type 2', which recommends using either the Cockcroft-Gault (CG) formula or the 'Modification of diet in renal disease' (MDRD) study formula to determine the estimated glomerular filtration rate (eGFR) as an indicator of renal function, in a cohort of patients with type-2 diabetes. DESIGN: Inventory. METHOD: The eGFR was calculated using the CG formula, the body-mass index (BMI-)corrected CG formula and the MDRD formula in 6224 patients with type-2 diabetes who entered the 'Zwolle outpatient diabetes project integrating available care' (ZODIAC) study in 2005. RESULTS: Using the CG and MDRD formulas, 31% and 63% of patients, respectively, had an eGFR of 30-59 ml/min (units for MDRD are ml/ min/1.73 m2) for which referral is advisable. In addition, 1% and 11%, respectively, had an eGFR <30 ml/min (reference: >90 ml/min), for which referral is necessary. Most patients aged >70 years (or > 50 years using the BMI-corrected CG formula) had an eGFR <60 ml/min. CONCLUSIONS: Reduced eGFR can be a sign of renal dysfunction but, using these formulas, can also be partly explained by advanced age. Therefore other factors should be considered when interpreting the results ofeGFR before it is concluded that the patient has kidney disease and the associated increased risk of cardiovascular disease.     

The relationship between serum creatinine and estimated glomerular filtration rate: implications for clinical practice

INTRODUCTION: A new classification of chronic kidney disease (CKD) has been widely adopted that stratifies patients into 5 'stages' according to estimated glomerular filtration rate (eGFR). In adults the most commonly used formulae to calculate eGFR are the Cockcroft and Gault (C and G) and Modification of Diet in Renal Disease (MDRD) formulae. The UK Renal Association has recommended calculation of MDRD eGFR to screen for reduced kidney function in primary and secondary care. AIM: The aim of this study was to explore the implication of using these predictive formulae. METHODS: We searched for patients currently attending a renal clinic who have ever had a serum creatinine (SCr) of exactly 100 micromol/L, 150 micromol/L or 200 micromol/L. The C and G and MDRD eGFRs corresponding to that SCr were calculated. The proportion of patients in each stage of the CKD classification was determined. RESULTS: For a SCr of 100 micromol/L mean eGFR was 86.5 ml/min (range 31.0 - 192.8) by C and G and 63.8 ml/min (range 39.7 - 99.9) by MDRD (p < 0.0001; t-test of mean). For SCr 150 micromol/L mean eGFR was 51.7 ml/min (18.0 - 110.4) by C and G and 38.0 ml/min (20.7 - 54.8) by MDRD (p < 0.0001). For SCr of 200 micromol/L mean eGFR was 34.4 ml/min (12.6 - 89.5) by C and G and 27.3 ml/min (16.7 - 41.3) by MDRD (p < 0.0001). Using MDRD eGFR 46.5% patients with a SCr of 100 micromol/L have stage 3 CKD (GFR 30-60 ml/min) and all patients with a SCr of 150 micromol/L or 200 micromol/L have CKD 3 or worse. 8.6% of males with SCr 100 micromol/L had stage 3 CKD or worse compared with 86.8% females. 70.2% patients > 65 years old with SCr 100 micromol/L had stage 3 CKD. CONCLUSIONS: Targeted screening of patients at-risk for CKD will identify a large number of patients who require management of CKD and potential referral to nephrology services even at levels of SCr regarded as 'normal' or mildly.     

Prevalence and determinants of chronic kidney disease in community-dwelling elderly by various estimating equations

ABSTRACT: Background Chronic kidney disease (CKD) represents a global public health problem. Few data exist in the elderly. The objective of the current study is to estimate the prevalence of CKD by means of various established and new equations and to identify the main determinants of CKD in elderly. Methods The ActiFE Ulm (Activity and Function in the Elderly in Ulm) study is a population-based cohort study in people of 65 years and older. Kidney function was assessed by means of estimated glomerular filtration rate (eGFR) based on two Creatinin- (Cr-; MDRD, CKD-EPI) and one Cystatin C - (CysC-) based method. The relationship between various potential risk factors and CKD was quantified using unconditional logistic regression. Results A total of 1471 subjects were in the final analysis (mean age 75.6 years, SD 6.56). Overall, prevalence of CKD (eGFR < 60 mL/min/1.73m2) was 34.3% by MDRD, 33.0% by CKD-EPI, and 14.6% by the CysC-based eGFR. All eGFRs showed statistically significant correlations with C-reactive protein, uric acid, as well as with lipid values. In multivariable analysis age was clearly related to prevalence of CKD and the risks were highest with the CysC-based equation. Females had a higher risk for CKD stages 3-5 with MDRD (OR 1.63; 95% CI: 1.23-2.16) whereas the OR was 1.23 (95% CI 0.92-1.65) with the CKD-Epi and OR= 0.89 (95% CI 0.58-1.34) with the CysC-based equation after multivariable adjustment. Although the cystatin C based definition of CKD resulted in a lower prevalence compared to the creatinine based ones, other measures of renal damage such as albuminuria were more prevalent in those defined by CysC-eGFR. Conclusions Prevalence of CKD is very variable based on the used estimating equation. More work is needed to evaluate the various estimating equations especially in elderly before we are able to assess the practical consequences of the observed differences.     

NLR联合ACR评估2型糖尿病早期肾损伤的临床分析

目的探讨中性粒细胞/淋巴细胞比值(NLR)联合尿微量白蛋白/尿肌酐比值(ACR)评估2型糖尿病早期肾损伤的临床价值。方法选取我院2018年1月至2019年5月期间收治的146例2型糖尿病患者,根据是否合并早期肾损伤分为糖尿病组(n=97)和早期糖尿病肾损伤组(n=49),选取同期体检的50例健康人员作为对照组。比较三组的实验室指标,探讨NLR、ACR在2型糖尿病早期肾损伤评估中的价值。结果早期糖尿病肾损伤组、糖尿病组的糖化血红蛋白、空腹血糖、餐后2h血糖、中性粒细胞及尿微量白蛋白均显著高于对照组(P<0.05);早期糖尿病肾损伤组的中性粒细胞、尿微量白蛋白均显著高于糖尿病组(P<0.05)。早期糖尿病肾损伤组的NLR、ACR水平均显著高于糖尿病组及对照组(P<0.05);糖尿病组的NLR、ACR水平与对照组相比,差异无统计学意义(P>0.05)。2型糖尿病早期肾损伤与NLR、ACR水平均呈正相关(r>0, P<0.05)。结论 NLR、ACR均是评估2型糖尿病早期肾损伤的敏感指标,可为疾病的早期诊断及治疗提供重要依据。     

联合尿N-乙酰-β-D-氨基葡萄糖苷酶和血半胱氨酸蛋白酶抑制剂C检测在糖尿病肾病早期诊断中的意义

目的 探讨联合检测尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)和血半胱氨酸蛋白酶抑制剂C(Cystatin C)对糖尿病肾病(DN)早期诊断的临床意义.方法 62例2型糖尿病患者(糖尿病组)根据24h尿白蛋白排泄量(24hUAE)分为三组,A组(正常白蛋白尿组,24hUAE<30mg)20例;B组(微量白蛋白尿组,24hUAE 30～300 mg)22例;C组(大量白蛋白尿组,24hUAE>300 mg)20例.另选择30例健康人作为对照组.收集并测定各组24hUAE、尿NAG活性,同时检测血清肌酐(SCr)及Cystatin C、采用Cockcroft-Gault公式计算内生肌酐清除率(Ccr),比较各组上述指标的变化.结果 糖尿病组尿NAG活性、血清Cystatin C水平均较对照组明显升高(P<0.01),Ccr显著降低(P<0.01);尿NAG活性、血清Cystatin C水平在糖尿病分组间逐渐升高(P<0.05或<0.01),而SCr增高在A组、B组差异无统计学意义(P>0.05).糖尿病组尿NAG活性、血清Cystatin C、24hUAE、SCr两两比较差异均有统计学意义,呈正相关(P<0.01),与Ccr均呈显著负相关(P<0.01).尿NAG活性和血清Cystatin C联合检测阳性率(80.6%,50/62)高于单项检测阳性率[分别为58.1%(36/62)和61.3%(38/62)](P<0.05).结论 尿NAG和血清Cystatin C是反映DN的敏感指标,联合检测可提高DN早期损害的检出率,有利于早期诊断.     

血清同型半胱氨酸检测在糖尿病肾病中的临床意义

目的探讨血清同型半胱氨酸检测在糖尿病肾病发生及发展中的临床价值。方法选择我院146例2型糖尿病患者,根据尿白蛋白排泄率和血肌酐水平分为单纯糖尿病组、早期糖尿病肾病组、临床糖尿病肾病组和肾衰竭组,30例健康体检者作为正常对照组,采用循环酶法分别检测其血清同型半胱氨酸水平并加以分析。结果各组血清同型半胱氨酸水平进行比较,糖尿病肾病组显著高于单纯糖尿病组,并且随着糖尿病患者肾脏损害程度的加重而升高,各组间比较差异均具有统计学意义(p<0.05)。结论高血清同型半胱氨酸水平与糖尿病患者肾脏损害程度相关,血清同型半胱氨酸水平有望作为糖尿病肾病的临床检测指标。     

血cystatinC及预测方程评价慢性肾脏病患者肾功能的对照研究

目的比较血清半胱氨酸蛋白酶抑制剂（Cystatin C）与临床常用的测定肾小球滤过率（GFR）的方法在慢性肾脏病（CKD）中的诊断价值。方法选取笔者所在科确诊的CKD患者72例,测定血清肌酐（Scr）、尿素氮（BUN）、血β2-MG和血清Cystatin C,并分别利用MDRD方程、Cockcroft—Gauh方程、Cystatin C方程计算GFR,比较各种方法与^99Tc^m-DTPA测得GFR之间的相关性;应用受试者工作特征曲线下面积（AUCROC）比较各种方法的准确性。结果血清Cystatin C与GFR呈明显负相关（P〈0．01）,较Cockcroft—Gault方程计算值及Scr、BUN相关性好。Cys C、1／MDRD—GFR、1／CG—GFR、1／Cys—GFR的AUCROC分别为0．998、0．905、0．865、0．997。结论血清Cystatin C是反映肾小球滤过功能比较敏感的指标,尤其在评价早期肾功能损害时的意义更大。