血清胱抑素C检测在2型糖尿病肾病诊断中的意义

目的:探讨胱抑素C(CysC)对2型糖尿病(T2DM)肾脏损伤的诊断意义。方法:对175例T2DM患者根据尿微量白蛋白排泄率(UAER)分为3组:正常蛋白尿(NA)组(UAER<30mg/24h),72例;微量蛋白尿(MA)组(UAER 30-300mg/24h),58例;临床蛋白尿(CDN)组(UAER>300mg/24h),45例;另选60例健康体检者作对照组。应用免疫透射比浊法测定血清CysC浓度,并比较各组的血清肌酐(Scr)、尿素氮(BUN)、β2-微球蛋白(β2-MG)和UAER。结果:T2DM患者5个项目的水平均明显高于对照组,差异均有统计学意义(P<0.01);MA组患者中CysC、β2-MG、UAER、Scr与对照组比较差异有统计意义(P<0.01或P<0.05);NA组患者CysC、β2-MG和UAER水平与对照组比较,差异均有统计学意义(P<0.05);CDN组患者CysC、Scr、BUN、β2-MG和UAER水平明显高于MA组和NA组,差异有统计学意义(P<0.01)。在NA组中CysC、Scr、Bun、β2-MG 4指标的异常检出率差异无统计学意义(P>0.05),但在MA组中,CysC、β2-MG 2指标的异常检出率明显高于Scr和Bun,差异有统计学意义(P<0.01)。结论:血清CysC检测在2型糖尿病肾脏损伤早期就开始异常并随着肾脏损害程度的加深而升高,说明血清CysC检测在2型糖尿病肾病早期诊断和了解肾脏损伤程度中有较高的临床意义。

Value of Serum Systatin C Detection in Type 2 Diabetic Nephropathy Diagnosis

Objective: To investigate the changes of serum cystatin C(CysC) in type 2 diabetes mellitus(T2DM) and its significance in the diagnosis of T2DM with renal injury.Methods: According to the levels of urinary albumin excretion rate(UAER),175 T2DM cases were divided into three groups as normal proteinuria(NA) group(UAER<30 mg/24 h,n=72);microalbuminuria(MA) group(UAER 30-300 mg/24 h,n=58),and clinical proteinuria(CDN) group(UAER>300 mg/24 h,n=45).Serum CysC concentration was determined by immune transmission turbidity method.Serum CysC,creatinine(Scr),blood urea nitrogen(BUN),β2-microglobulin(β2-MG),and UAER were compared among the three groups.Another 60 healthy subjects were included as control group.Results: All the five indices were significantly higher in T2DM patients than in control group(P<0.01);CysC,β2-MG,UAER,and Scr levels in MA group were significantly different from that respectively in control group(P<0.01 or P<0.05,respectively);In CDN group,CysC,Scr,BUN,β2-MG and UAER levels were significantly higher than that respectively in MA group and NA group(all P<0.01).In MA group,positively detected rates were not different statistically in CysC,Scr,Bun,and β2-MG(P>0.05).But in MA group,the positive rates of CysC and β2-MG were significantly higher than those of Scr and Bun(P<0.01).Conclusion: Serum CysC changed early in type 2 diabetic kidney injury,and the level is increasing according to the deteriorating of kidney injury.Serum CysC detection is useful in early diagnosis of type 2 diabetic nephropathy and in evaluating the degrees of renal injury of T2DM.