血清同型半胱氨酸与胱抑素C对2型糖尿病肾病的早期诊断价值

目的探讨2型糖尿病肾病(DN)早期患者血清同型半胱氨酸(Hcy)、胱抑素C(CysC)水平的变化及临床价值。方法根据尿清蛋白排泄率(urinary albumin exeretion rate,UAER)将88例2型糖尿病患者分为糖尿病无肾病组(DM组,36例,UAER<20μg/min),糖尿病早期肾病组(DN组,52例,UAER 20～200μg/min),对观察组和40例健康对照组的血清同时进行Hcy、CysC、血清肌酐(Cre)、尿素氮(Bun)平行检测,并作对比分析。结果 DN组和DM组Hcy、CysC明显高于健康对照组(P<0.05),DN组Hcy、CysC亦高于DM组(P<0.05);DN组Cre、Bun略高于DM组(P>0.05),DN组Cre、Bun亦高于健康对照组(P>0.05);DN组阳性率CysC(65.4%)>Hcy(50%)>Cre(26.9%)>Bun(23.1%)。结论血清Hcy、CysC是较理想的反映肾小球滤过率(GFR)的血清指标,在糖尿病肾病诊断时间上较血清肌酐、尿素氮更早,可作为糖尿病肾病早期预测指标。

The early diagnostic value of serum homocysteic acid and cystatin C in patients with diabetic nephropathy

Objective To evaluate the early clinical value of serum homocysteic acid （Hcy） and cystatin C （CysC） in patients with diabetic nephropathy（DN）. Methods Eighty-eight patients with DM were divided into two groups according to urinary albumin excretion rate （UAER）, these were DM groups（36 cases, UAER（20 μg/min） and DN groups（52 cases, UAER 20-200 μg/min）. Serum Hcy, CysC, Cre, Bun were detected and parallelly contrasted between DN groups,DM groups and control group with fourty healthy people. Results The serum Hcy, CysC levels in DN groups and DM groups were obviously higher than those in health controls, the difference among them was significant （P〈0.05）. In DN groups, the levels of the serum H cy, CysC were also higher than those in DM groups （P〈0.05）. However,the differences of the Cre,Bun levels among DN groups,DM groups and health groups were not significant（P〉0.05）. The positive rates in DN groups in turn were respectively CysC （65. 4%）, Hcy （50 % ）, Cre（26.9% ）, Bun（23.1% ）. Conclusion The serum Hcy and CysC are more sensitive and specific markers for glomerular filtration rate （GFR）. The serum Hcy and CysC are superior to serum creatinine （Cre） and blood BUN nitrogen （Bun） as predictive markers of renal impairment in an early stage.