血清半胱氨酸蛋白酶抑制剂C和同型半胱氨酸联合检测在儿童早期糖尿病肾病中的诊断意义

目的探讨血清半胱氨酸蛋白酶抑制剂C（Cys-C）和同型半胱氨酸（HCY）联合检测对儿童糖尿病早期肾损伤的诊断意义。方法将92例糖尿病患儿根据24h尿白蛋白排泄率（UAER）分为3组（B、C、D）,其中B组为正常白蛋白尿组（UAER〈30mg/24h,33例）,C组为微量白蛋白尿组（30mg/24h≤UAER≤300mg/24h,28例）,D组为大量白蛋白尿组（UAER〉300mg/24h,31例）。选择同期42例正常体检儿童为对照组（A组）。同时测定各组儿童血清胱抑素C（Cys-C）、同型半胱氨酸（HCY）、肌酐（Scr）、尿素氮（BUN）和尿酸（UA）水平,采用Cockroft-Gault公式计算内生肌酐清除率（Ccr）,并对各组上述指标进行统计学比对分析。结果糖尿病各组患儿血清Cys-C、HCY、Scr、BUN、UA与对照组比较均升高,同时其水平随UAER的逐渐升高而升高,Ccr与对照组比较则逐渐下降。B、C、D3组中Cys-C、HCY水平与A组比较差异均有统计学意义（P〈0.05）。糖尿病各组各项指标两两比较差异均有统计学意义（P〈0.05）。血清Cys-C和HCY联合检测的阳性率为76.1%,高于Cys-C和HCY单独检测的阳性率（59.8%、56.5%,P〈0.05）。结论血清中Cys-C和HCY是反映早期肾功能损害的灵敏指标,Cys-C和HCY的联合检测可早期反映糖尿病肾损伤的程度。

Diagnostic value of combined measurement of serum cystatin C and homocysteine in children diabetes nephropathy in early stage

Objective To study the value of combined measurement of serum cystatin C（Cys-C） and homocysteine（HCY） in diagnosing diabetic nephropathy in early phase. Methods 92 children patients with diabetes were divided into 3 groups according to their urinary albumin excretion rate（UAER）：group B （normal albuminuria, UAER/24 h30 mg,33 cases）;group C （microalbuminuria,30 mg≤UAER/24 h≤300 mg,28cases） and group D （substantial albuminuria UAER/24 h300 mg, 31 cases）. Group A was control （healthy children,42 cases）. Serum cystatin C, Homocysteine, serum creatinine （Scr）, uric acid and urea nitrogen were measured, and creatinine clearance rate （Ccr） was calculated. All indexes in each group were compared and analyzed. Results The levels of Cys-C, HCY, Scr, BUN and UA in each diabetic group were higher than those in group A,and the levels were correlated with the elevation of the urinary albumin excretion rate. The Ccr in each diabetic group was lower than that in group A. The levels of Cys-C and HCY in group B, C and D were significantly higher than those in group A. There were significant differences of all indexes between two groups in diabetic groups（P0.05）.The positive rate of combined measurement of serum cystatin C and Homocysteine was 76.1%. It was higher than that of the single one （59.8%,56.5%,P0.05）. Conclusion Serum Cys-C and HCY can be used as an earlier diagnostic marker for children diabetes nephropathy.