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目的探讨血清胱抑素C(Cystatin C,Cys C)与利用Cys C估算的e GFR-cys对于早期诊断糖尿病肾病的临床应用价值。方法根据尿白蛋白排泄率将126例2型糖尿病患者分为单纯糖尿病组和糖尿病肾病组,对其空腹血糖(FBG)、餐后2 h血糖(2h PBG)、糖化血红蛋白(Hb A1c)、24 h尿蛋白定量(24 h UPQ)、血肌酐(Scr)、尿素氮(BUN)、血清胱抑素C(Cys C)进行检测,根据简化的MDRD方程估算肾小球滤过率(e GFR),使用CHINAcys方程估算e GFR(e GFR-cys)。使用受试者工作特征曲线(Receiver Operator Characteristic curve,ROC)分析各项指标的诊断价值。结果与单纯糖尿病组相比,糖尿病肾病组的24 h UPQ、BUN、Scr、Cys C显著升高,e GFR-MDRD、e GFR-cys显著降低,差异有统计学意义(P<0.01)。Cys C及e GFR-cys与24 h UPQ、Bun、Scr及e GFR-MDRD均有一定的相关性,Cys C与e GFR-MDRD相关性最大,相关系数为-0.681;4 h UPQ、Cys C与e GFR-cys的AUC>0.75,这3项指标诊断DN的效能优于BUN、Scr与e GFR-MDRD。当以e GFR-cys<60[ml·min-1(173m2)-1],Cys C>0.98mg/L为截点时,e GFR-MDRD+Cys C联合诊断DN的敏感度和约登指数分别为87.35%与0.710,均高于BUN、Cys C、Scr、e GFR-MDRD。结论 e GFR-MDRD、Cys C 2项指标联合筛查发现真正的DN患者与单纯糖尿病患者的效果好,真实性大且敏感性强。
Objective To investigate the clinical value of serum cystatin C (Cys C) and e GFR-cys estimated by Cys C in the early diagnosis of diabetic nephropathy. Methods According to urinary albumin excretion rate, 126 patients with type 2 diabetes were divided into simple diabetic group and diabetic nephropathy group. Their fasting blood glucose (FBG), postprandial 2h PBG, Hb A1c, 24 h urinary protein (24 h UPQ), serum creatinine (Scr), blood urea nitrogen (BUN) and serum cystatin C (Cys C) were measured. The glomerular filtration rate (e GFR) The eGFR (eGFR-cys) was estimated using the CHINAcys equation. The receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of each indicator. Results Compared with simple diabetic group, the levels of UPQ, BUN, Scr and Cys C at 24 h and the levels of e GFR-MDRD and e GFR-cys in diabetic nephropathy group were significantly decreased (P <0.01). Cys C and e GFR-cys had some correlation with 24 h UPQ, Bun, Scr and eGFR-MDRD, Cys C had the highest correlation with eGFR-MDRD with a correlation coefficient of -0.681; 4 h UPQ, Cys C The AUC> 0.75 with eGFR-cys was superior to BUN, Scr and eGFR-MDRD in diagnosing DN. When GFR-cys <60 [ml · min-1 (173m2) -1] and Cys C> 0.98 mg / L were used as cut-off points, the sensitivity and the Youden index of e GFR- 87.35% and 0.710, all higher than BUN, Cys C, Scr, e GFR-MDRD. Conclusions The combination of e GFR-MDRD and Cys C 2 index screening found that patients with true DN had better effect, higher authenticity and more sensitivity than those with simple diabetes.