| | | | | 胱抑素C测定在糖尿病肾病肾功能评价中的应用 | | | 张培培;刘志红;谢红浪;葛永纯;李世军;王生余;黎磊石 | | | 目的:探讨血清胱抑素C(cystatin C,Cys-C)检测在糖尿病肾病(DN)患者肾功能评价中的诊断价值。方法:经临床及肾活检确诊的2型糖尿病、DN患者83例。免疫比浊法测定血清Cys-C浓度。同时测定血肌酐水平(SCr)、BMI数值、肾小管功能指标(NAG酶,RBP、尿渗量)、尿蛋白水平、血清白蛋白、尿酸水平、同位素99mTc-DTPA测定肾小球滤过率(GFR)。分析不同肾功能状态下Cys-C,SCr、MDRD公式与ECT-GFR的相关性。进一步根据肾小管功能指标、蛋白尿程度、血清白蛋白水平、代谢指标(血清尿酸、BMI)分组,分析Cys-C、SCr与GFR的相关性差别。以ECT-GFR为标准,作Cys-C、SCr的受试者工作特性曲线(receiver operator characteristic curve,ROC),并求其曲线下面积(area under the curve,AUC)。结果:(1)Cys-C、SCr与ECT-GFR的Pearson相关系数r分别为-0.740和-0.663(P<0.01),Cys-C与GFR的相关性较SCr更好。GFR≤60ml/min时,Cys-C、MDRD-GFR、SCr与GFR的相关系数r分别为-0.798,0.760,-0.716(P<0.01),Cys-C与GFR的相关性优于SCr和MDRD公式;GFR>90ml/min时,Cys-C、SCr与GFR的相关系数r分别为-0.561vs-0.465(P<0.05)。Cys-C与GFR的相关性优于SCr。(2)患者肾小管功能受损状态下:NAG酶>20u/g.cr时,Cys-C、SCr与GFR的相关系数r分别为-0.660vs-0.595(P<0.01);RBP>2mg/L时,r值分别为-0.672vs-0.635(P<0.01);尿渗量≤600mOsm/kg.H2O时,r值分别为-0.696vs-0.663(P<0.01)。Cys-C与GFR的相关性均较SCr更好。(3)尿蛋白>1g/24h时,Cys-C、SCr与GFR的相关系数r分别为-0.704vs-0.649(P<0.01)。血清白蛋白≤35g/L时,r值分别为-0.635vs-0.581(P<0.01)。Cys-C与GFR的相关性均较SCr更好。(4)不同血清尿酸、BMI状态下,Cys-C与GFR的相关系数r值不受影响。ROC中曲线下面积(AUC),Cys-C、SCr分别为0.915vs0.902(P<0.01),仍以Cys-C更灵敏和特异。结论:DN患者各期(包括早期高灌注期、肾功能损害期),Cys-C与GFR之间的相关性优于SCr、MDRD公式。DN患者出现肾小管功能损害时,Cys-C与GFR仍有较好的相关性。DN患者出现蛋白尿、血清白蛋白下降时,Cys-C仍可较好地反映肾功能。而代谢性指标不影响Cys-C与GFR的之间的相关性。Cys-C可作为一个更好的反映DN患者肾功能变化的内源性指标。
【作者单位】：南京大学医学院临床学院;南京军区南京总医院解放军肾脏病研究所;南京军区南京总医院解放军肾脏病研究所;南京军区南京总医院解放军肾脏病研究所;南京军区南京总医院解放军肾脏病研究所;南京军区南京总医院解放军肾脏病研究所;南京军区南京总医院解放军肾脏病研究所 博士研究生;(南京;210002);(南京;210002);(南京;210002);(南京;210002);(南京;210002);(南京;210002)
【关键词】：胱抑素C;糖尿病肾病;血肌酐;肾小管损害;蛋白尿;BMI;血尿酸
【分类号】：R692
【DOI】：CNKI:SUN:SZBY.0.2007-06-002
【正文快照】：
糖尿病肾病(diabetic nephropathy,DN)患者的肾功能评价具有特殊性。糖尿病是一个全身代谢性疾病,其大血管及微血管并发症成为导致机体重要器官(心、脑、肾、眼)功能减退的重要原因。此外患者年龄、高血压、高血脂以及药物治疗、合并感染等多方面因素均会对肾功能造成影响。Cystatin C(Cys-C)作为近年新的内源性肾功能指标,其变化受年龄、性别、饮食和肾小管功能的影响比较小,是一个较为理想的内源性GFR指标。本文旨在探讨Cys-C测定在DN患者肾功能评价中的应用。对象和方法研究对象2006年9月至2007年6月解放军肾脏病研究所经临床及肾… | | |  推荐 CAJ下载  PDF下载 | | | CAJViewer7.0阅读器支持所有CNKI文件格式，AdobeReader仅支持PDF格式 | | | | Evaluation of renal function in patients with diabetic nephropathy using cystatin C | | | ZHANG Peipei;LIU Zhihong;XIE Honglang;GE Yongchun;LI Shijun;WANG Shengyu;LI Leishi Research Institute of Nephrology;Jinling Hospital;Nanjing University School of Medicine;Nanjing 210002;China | | | Objective:To evaluate the Cystatin C(Cys-C)as a marker of renal function in patients with diabetic nephropathy(DN).Methodology:Eight three patients with DN were enrolled in this study.Serum Cys-C was tested by immunoturbidimetry,and serum creatinine(SCr)was measured at the same day.Radionuclide 99mTc-DTPA was used to evaluate glomerular filtration rate(ECT-GFR).The tubular markers(NAG enzyme,retinol binding protein,urine osmotic pressure),24-hour urine proteinuria excretion,serum albumin,and uric acid were also measured.The correlation between Cys-C,SCr,MDRD-GFR and ECT-GFR was evaluated in the different renal stages.Further more,the correlation of Cys-C and GFR was detected in different level of tubular function,proteinuria,serum albumin,uric acid and BMI.Receiver operator characteristic curve(ROC curve)of Cys-C and SCr was made by ECT-GFR as standard,and calculated the area under the curve(AUC).Results:(1)In the whole study population:the Pearson correlation coefficient of Cys-C,SCr and ECT-GFR was-0.740,-0.663,respectively(P<0.01).Cys-C correlated with GFR better than SCr.When GFR was less than 60ml/min,the correlation coefficient of Cys-C,MDRD-GFR,SCr and GFR was-0.798,0.760,-0.716,respectively(P<0.01).Cys-C correlated with GFR better than SCr or MDRD formula.When GFR was more than 90 ml/min,the correlation coefficient of Cys-C,SCr and GFR was-0.561,-0.465,respectively(P<0.05).Cys-C was also correlated with GFR better than SCr.(2)In the patients with tubular impairment:when NAG enzyme was more than 20 u/g·cr,the correlation coefficient of Cys-C,SCr and GFR was-0.660,-0.595,respectively(P<0.01);when RBP was more than 2 mg/L,the correlation coefficient was-0.672,-0.635,respectively(P<0.01);and when Urine osmolarity was less than 600 mOsm/kg·H_2O,the correlation coefficient was-0.696,-0.663,respectively(P<0.01).Cys-C was alsocorrelated with GFR better than SCr when tubular damage occurred.(3)When proteinuria was more than 1 g/24hr,the correlation coefficient of Cys-C,SCr and GFR was-0.704,0.649,respectively(P<0.01).When the concentration of serum albumin was less than 35g/L,the correlation coefficient of Cys-C,SCr and GFR was-0.635,0.6581,respectively(P<0.01).Cys-C was also correlated with GFR better than SCr in cases with heavy proteinuria.(4)In different levels of serum uric acid or BMI,the correlation was not affected.In the ROC,the AUC of Cys-C and SCr was 0.915 vs 0.902,respectively(P<0.01)(GFR 90ml/min as cut off value),Cys-C was more sensitive and specific.Conclusion:Cys-C may be correlated with GFR better than SCr in type 2 diabetic patients with different renal stages,including early hypertransfusion period or overt renal dysfunction state.In patients with renal tubular dysfunction or medium to massive urine protein,renal function could be evaluated by Cys-C better.Cys-C is not affected by metabolic index.Thus,Cys-C could be an ideal endogenous marker of GFR in DN patients.
【Keyword】：Cystatin C diabetic nephropathy serum creatinine impairment of renal tubule proteinuria BMI serum uric acid |
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