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目的:研究血清胱抑素C,TNF-α及血尿酸水平变化在治疗糖尿病肾病中的作用,以及对早期肾功能诊断分析的意义,以供临床治疗作为参考。方法:选择2014年9月—2015年9月在宁波市北仑人民医院就诊的64例糖尿病肾病患者,其中男性43例,女性21例,年龄36~72岁,平均年龄(54.2±3.4)岁。对照组患者14例,均为体检合格的健康人士。全部研究组患者均符合1990年WHO糖尿病专家委员会的标准确诊为糖尿病肾病,依照糖尿病肾病尿蛋白量的多少分成3组:糖尿病正常尿蛋白组患者14例,尿蛋白排泄率(UAER)<1.2mg/h;糖尿病肾病微量尿蛋白组25例,尿蛋白排泄率(UAER)=(1.8~18)mg/h;糖尿病肾病大量尿蛋白组25例,尿蛋白排泄率(UAER)≥18 000mg/h以上。所有受试患者均分别进行血清胱抑素C,TNF-α及血尿酸水平的检测,并对比4组之间的异同以及相关分析及诊断。以上各个组的受试患者,性别、年龄及试验构成均不具有统计学意义(P<0.05),但存在可比性。结果:对照组和研究组受试患者血清胱抑素C进行分析,发现研究组各组的血清胱抑素C的结果明显高过对照组;对照组与正常尿蛋白组比较,肌酐清除率、血肌酐以及尿素氮均有所下降;对照组与微量尿蛋白组的比较结果显示,以上3项指标均出现了较为显著的降低;而大量尿蛋白组则相较于对照组、正常尿蛋白组和微量尿蛋白组,3个项目的评分降低的最为明显;而各项指标两两对比,其余3项指标没有出现十分明显的变化同时,血清胱抑素C已经产生了显著变化,而且随着受试患者病情的加重变化幅度也逐渐增加,所有项目差异均有统计学意义(P<0.05)。结论:通过血清胱抑素C的检测来判断糖尿病肾病的严重程度有着较好作用。TNF-α浓度的变化情况在糖尿病肾病的过程中作为评判标准则更为准确。同时血尿酸水平变化也能较好的反应该病症的患病情况。以上3种项目对早期肾功能的的诊断分析均具有十分重大的意义。
Objective: To study the role of serum cystatin C, TNF-α and serum uric acid in the treatment of diabetic nephropathy, as well as the significance of the diagnosis of early renal function for clinical treatment as a reference. Methods: Sixty-four patients with diabetic nephropathy were treated in Beilun People’s Hospital of Ningbo City from September 2014 to September 2015. There were 43 males and 21 females, aged from 36 to 72 years and mean age of 54.2 ± 3.4 years. The control group of patients in 14 cases, all healthy people who passed the examination. All the study groups were diagnosed with diabetic nephropathy according to the criteria of the 1990 Committee of Experts on Diabetes Mellitus. According to the quantity of urinary protein in diabetic nephropathy, the patients were divided into three groups: 14 patients with normal urinary protein group, urinary protein excretion rate (UAER) <1.2mg / h; Microproteinuria in diabetic nephropathy 25 cases, urinary protein excretion rate (UAER) = (1.8 ~ 18) mg / h; Diabetic nephropathy in a large number of urine protein group 25 cases, urinary protein excretion rate (UAER) the above. All patients were tested for serum levels of cystatin C, TNF-α and serum uric acid, and compared the similarities and differences between the four groups and related analysis and diagnosis. The above groups of patients tested, sex, age and test composition were not statistically significant (P <0.05), but there is comparability. Results: The results of serum cystatin C in the control group and study group were significantly higher than those in the control group. The serum creatinine clearance rate, Serum creatinine and urea nitrogen were decreased; the control group and microalbuminuria results show that the above three indicators were more significant decrease; while a large number of urine protein group compared with the control group, normal urine protein group And microalbuminuria, the scores of the three items decreased the most obviously. However, the indexes of all the three groups did not change obviously while the other indexes did not change significantly. At the same time, the serum cystatin C had a significant change, The severity of the patients’ changes also gradually increased, all the differences were statistically significant (P <0.05). Conclusion: It is effective to judge the severity of diabetic nephropathy by detecting serum cystatin C. Changes in the concentration of TNF-α in the course of diabetic nephropathy as a criterion is more accurate. At the same time changes in serum uric acid levels can also better reflect the prevalence of the disease. The above three kinds of items on the diagnosis of early renal function are of great significance.