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目的评价临床上常用的测定肾小球滤过率(GFR)的指标在2型糖尿病患者的适用性。方法 2型糖尿病患者60例,以体表面积标准化的双血浆法~(99)Tc~m-DTPA 血浆清除率测定值(rGFR)作为测定 GFR 的参考指标,比较血肌酐(Scr)、肌酐清除率(Ccr)、~(99)Tc~m-DTPA。肾动态显像法(gGFR)、基于 Scr 的 GFR 评估方程7(MDRD 7)以及血清半胱氨酸蛋白酶抑制剂 C(cystatin C,Cys C)等多种方法与 rGFR 的相关性,测定上述方法在反映2型糖尿病患者肾功能减退的特异性和敏感性,用受试者工作特征曲线(ROC)评价上述指标检测肾小球滤过功能的准确性。结果 2型糖尿病患者60例,其中男35例,女25例,年龄(62.4±11.7)岁,病史(10.66±9.35)年,Scr、Ccr、gGFR、MDRD 7及 Cys C 测定结果均与 gGFR 呈显著相关(r 分别为-0.500、0.675、0.367、0.428及-0.588,P 均<0.001),其中 Ccr 与 rGFR 值相关性最好,其次为 Cys C。Ccr、MDRD 方程7及 Cys C 在判断GFR 下降时的敏感度较高(分别为82.1%、85.7%及85.7%),显著高于 Scr 及 gGFR 方法(10.7%及46.6%,P<0.01);Scr 在判断 GFR 下降时的特异度为100%,显著高于 MDRD 方程7的特异度(25.0%,P<0.01)。Cys C 和 Ccr 的受试者工作特征曲线(ROC)下面积显著高于 Scr,MDRD 方程7和 gGFR。Cys C 的最佳判定域值为1.18 mg/L,该域值的敏感度和特异度分别为80%和57.5%;Ccr的最佳判定域值为62 ml/min,该域值的敏感度和特异度分别为90%和67.9%。结论 Ccr 和Cystatin C 能够较理想地反映2型糖尿病患者 GFR 的变化。
Objective To evaluate the applicability of the commonly used index in the determination of glomerular filtration rate (GFR) in type 2 diabetic patients. Methods Sixty patients with type 2 diabetes mellitus (T2DM) were enrolled in this study. Serum creatinine (Scr), creatinine clearance (Ccr), ~ (99) Tc ~ m-DTPA. (GGFR), GFR assessment based on Scr 7 (MDRD 7) and serum cystatin C (Cys C) and other methods and rGFR correlation of a variety of methods to determine the above method In reflecting the specificity and sensitivity of renal dysfunction in type 2 diabetic patients, the accuracy of the above indexes in detecting glomerular filtration rate was evaluated by receiver operating characteristic curve (ROC). Results There were 60 patients with type 2 diabetes mellitus, including 35 males and 25 females, with a mean age of (62.4 ± 11.7) years and a history of (10.66 ± 9.35) years. The results of Scr, Ccr, gGFR, (R = -0.500,0.675,0.367,0.428 and -0.588, respectively, P <0.001). The correlation between Ccr and rGFR was the best, followed by Cys C. Ccr, MDRD equation 7 and Cys C had higher sensitivity (82.1%, 85.7% and 85.7%, respectively) in judging the decline of GFR, which was significantly higher than that of Scr and gGFR (10.7% and 46.6%, P <0.01); The specificity of Scr in determining GFR decline was 100%, significantly higher than that of MDRD equation 7 (25.0%, P <0.01). The area under the receiver operating characteristic curve (ROC) for Cys C and Ccr was significantly higher than Scr, MDRD Equation 7 and gGFR. The best discriminant value of Cys C was 1.18 mg / L, the sensitivity and specificity of this region were 80% and 57.5%, respectively. The best discriminant value of Ccr was 62 ml / min. The sensitivity And specificity of 90% and 67.9%, respectively. Conclusion Ccr and Cystatin C can better reflect the changes of GFR in type 2 diabetic patients.