成年人群血清胱抑素C与同型半胱氨酸水平升高的疾病谱分析

目的　探讨并分析成年人群血清胱抑素C（Cys-C）和同型半胱氨酸（Hcy）升高的疾病谱。方法　选取空军特色医学中心711例住院和门诊患者，于Beckman AU2700全自动生化分析仪上同时检测Cys-C和Hcy，检测方法分别为免疫比浊法和循环酶法；采用回顾性分析的方法统计所有人群的疾病诊断信息，按照高血压、肿瘤、心脑血管疾病、代谢性疾病（主要包括高尿酸、高血脂等）、高血糖、胃肠道疾病、呼吸系统疾病、泌尿系统疾病、肝胆系统疾病、眼科疾病和甲状腺疾病等进行分类；以Cys-C等于1.05mg/L为界限，分为两组:≤1.05mg/L组（A组:Cys-C ≤1.05mg/L）和＞1.05mg/L组（B组:Cys-C>1.05mg/L），Hcy>15.0μmol/L认为Hcy升高，分别比较Hcy升高与不升高的疾病诊断内容。结果　在A组，诊断为高血压和胃肠道相关疾病的占比分别为20%和19%，诊断为心脑血管疾病、代谢性疾病及肿瘤的占比平均在10%左右，其余呼吸、泌尿和肝胆等疾病的占比均低于5%。B组中，诊断为高血压的比例最高为33%，占比明显升高，胃肠道疾病的占比明显降低，诊断为心脑血管疾病、胃肠道疾病及代谢性疾病的占比平均在10%左右，其余呼吸、泌尿、肝胆和肿瘤等疾病的占比均≤5%，其余系统疾病较A组差别较小。A组中Hcy>15.0μmol/L诊断为泌尿系统疾病的病例占比为75%，呼吸系统的占比为40%，诊断为其余疾病的占比在30%以下。B组中部分诊断为同类疾病的占比较A组明显增加，增加倍数可达2～7倍，主要体现在以下疾病中:高血压、脑血管病、代谢性疾病、心血管病、糖尿病、胃肠道疾病、呼吸系统疾病、泌尿系统疾病以及肝胆系统疾病。结论　Cys-C伴Hcy升高的疾病诊断多集中于高血压、代谢综合征、心脑血管疾病及肾脏等疾病；Cys-C与Hcy在多种疾病中都具有相关性，二者同时升高对代谢综合征的评估、高血压和心脑血管疾病的诊断，尤其对肾脏病的诊断具有明确的意义。临床应重视Cys-C与Hcy同时检测对不同疾病的诊断价值，合理开具检测项目。

Disease Spectrum Analysis of Serum Hypercystatin C Accompanied by Hyperhomocysteine in Adults Population

Objective To investigate the disease distribution of hyper-cystatin C(Cys-C)accompanied by hyper-homocysteine(Hcy)in adults.Methods 711 inpatients and outpatients in Air Force Medical Center were involved in this research.Cys-C and Hcy were respectively detected at the same time by immune-turbidimetric method and circulating enzyme method respectively in AU2700 automatic biochemical analyzer.The disease diagnosis information of patients was retrospectively analyzed and classified,including hypertension,tumor,cardiovascular and cerebrovascular disease,metabolic disease(mainly including hyperuricemia and hyperlipidemia),hyperglycemia,gastrointestinal disease,respiratory system disease and urinary tract disease system diseases,hepatobiliary system diseases,ophthalmic diseases,thyroid diseases,etc.According to Cys-C equal to 1.05mg/L as the demarcation line,the patients were divided into two groups:less than or equal to 1.05mg/L group(group A:Cys-C≤1.05mg/L)and more than 1.05mg/L group(group B:Cys-C>1.05mg/L).Hcy>15.0μmol/L was considered as hyperhomocysteinemia.The diagnosis contents of diseases were contrasted between elevated Hcy and without Hcy elevation.Results In group A,the proportion of patients diagnosed with hypertension and gastrointestinal diseases were 20%and 19%,respectively.The average proportion of patients diagnosed with cardiovascular and cerebrovascular diseases,metabolic diseases and tumors was about 10%,and the proportion of other respiratory,urinary,hepatobiliary and other diseases was less than 5%.In group B,the proportion of patients diagnosed with hypertension was 33%,which was significantly higher than that of group A,and the proportion of gastrointestinal diseases was significantly decreased.The average proportion of patients diagnosed as cardiovascular and cerebrovascular diseases,gastrointestinal diseases and metabolic diseases was about 10%.The proportion of respiratory,urinary,hepatobiliary,tumor and other diseases was equal to or less than 5%.The difference in other system diseases was smaller than that of group A.In group A,75%of patients were diagnosed urinary diseases and 40%of patients were diagnosed respiratory diseases in patients with Hcy>15.0μmol/L.Other diseases accounted for less than 30%.In group B,the proportion of patients diagnosed as the same kind of disease was significantly higher than that in group A,and the increase times could reach 2~7 times.These diseases mainly included the following diseases:hyperten sion,cerebrovascular disease,metabolic disease,cardiovascular disease,diabetes,gastrointestinal disease,respiratory system disease,urinary system disease and hepatobiliary system disease.Conclusion Cys-C with Hcy increasing was more common in hypertension,metabolic syndrome,cardiovascular and cerebrovascular diseases and kidney diseases.Cys-C and Hcy were correlated in many diseases,and both of them increased at the same time.It is of great significance to evaluate metabolic syndrome,diagnose hypertension and cardiovascular and cerebrovascular diseases,especially for kidney disease.Clinical attention should be paid to the simultaneous detection of Cys-C and Hcy for the diagnostic value of different diseases,and reasonable write out test items.