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目的:探讨血清胱抑素C(Cys-C)和同型半胱氨酸(Hcy)在老年2型糖尿病肾病(DN)中的早期诊断价值。方法:随机抽取2014年1月至2016年4月来本院就诊并确诊为单纯2型糖尿病(T2DM)患者50例,早期DN患者52例、临床期DN患者54例,另抽取50名来本院体检的健康者作为对照组,检测各组患者血清Cys-C、Hcy水平和肾功能相关指标。应用多元Logistic回归分析早期DN的危险因素,绘制患者检验学指标ROC曲线评价Cys-C、Hcy水平在早期DN中的诊断价值。结果:病程、HbA1c、Cys-C、Hcy及UAER是早期DN的独立危险因素。ROC曲线结果表明Cys-C+Hcy可作为早期DN临床诊断指标,Youden指数达到0.614。对52例早期DN患者,血清Cys-C检测阳性率为57.7%,血清Hcy检测阳性率为53.8%,而两者联合检测的检测阳性率为76.9%,差异有统计学意义(P<0.05)。结论:血清Cys-C和Hcy均可反映早期肾功能的损伤,联合检测对老年2型DN的早期诊断具有重要的意义。
Objective: To investigate the early diagnostic value of serum cystatin C (Cys-C) and homocysteine (Hcy) in type 2 diabetic nephropathy (DN). Methods: From January 2014 to April 2016, 50 patients with T2DM were randomly selected from our hospital from January 2014 to April 2016. There were 52 patients with early DN, 54 patients with clinical DN and 50 patients The healthy subjects in the hospital were taken as the control group to detect the serum Cys-C, Hcy levels and renal function-related indexes in each group. Multivariate logistic regression analysis was used to analyze the risk factors of early DN, and the ROC curve of patient test was drawn to evaluate the diagnostic value of Cys-C and Hcy in early DN. Results: The course of disease, HbA1c, Cys-C, Hcy and UAER were independent risk factors of early stage DN. ROC curve results show that Cys-C + Hcy can be used as an early clinical diagnosis of DN, Youden index reached 0.614. The positive rate of serum Cys-C in 52 cases of early DN was 57.7% and the positive rate of serum Hcy was 53.8%. The positive rate of Cys-C was 76.9% (P <0.05) . Conclusion: Serum Cys-C and Hcy can both reflect the early renal function injury. The combined detection is of great significance for the early diagnosis of type 2 DN in the elderly.