【摘要】 目的 以99mTc-DTPA腎動(dòng)態(tài)顯像法腎小球?yàn)V過(guò)率（glomerular filtration rate，GFR）測(cè)定為標(biāo)準(zhǔn)，將血清胱抑素C（cystatin C， CysC）檢測(cè)與其比較，探討CysC測(cè)定在2型糖尿病腎?。╰ype 2 diabetic nephropathy，T2DN）診斷中的意義。 方法 2010年6月—2011年1月76例2型糖尿?。╰ype 2 diabetes mellitus，T2DM）患者按24 h尿微量白蛋白（microalbuminuria，m-Alb）分為兩組:正常蛋白尿組（31例）和微量蛋白尿組（45例），同時(shí)測(cè)定GFR、CysC、血清肌酐（serum creatinine， Scr）和糖化血紅蛋白（hemoglobin A1c， HbA1c），并設(shè)正常自愿者38名作為對(duì)照組，進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果 對(duì)照組、T2DM正常蛋白尿組及T2DM微量蛋白尿組CysC水平分別為（1.1±0.6）、（1.6±0.7）、（1.0±0.3） mg/L，各組差異均有統(tǒng)計(jì)學(xué)意義（P lt;0.05）；HbA1c水平分別為（5.4±0.6）%、（7.1±2.7）%、（7.9±3.1）%、兩組T2DM患者與對(duì)照組比較，差異均有統(tǒng)計(jì)學(xué)意義（P lt;0.05）；GFR水平分別為（80.9±23.0）、（74.2±26.1）、（79.3±19.7） mL/（min?1.73 m2），各組差異無(wú)統(tǒng)計(jì)學(xué)意義（P gt;0.05）；Scr水平分別為（87.7±23.8）、（93.7±38.4）、（81.5±11.4） μmol/L，組間差異無(wú)統(tǒng)計(jì)學(xué)意義（P gt;0.05）。CysC、Scr和GFR之間呈負(fù)相關(guān)（r=-0.694，-0.692；P lt;0.001）；CysC和Scr之間呈正相關(guān)（r=0.903，P lt;0.001）。 結(jié)論 CysC可作為早期T2DN的檢測(cè)指標(biāo)，具有較高的敏感性，但對(duì)于輕度到中度GFR降低的診斷準(zhǔn)確性并不優(yōu)于Scr。
【Abstract】 Objective To demonstrate the clinical value of serum cystatin-C (CysC) in the assessment of renal function in type-2 diabetic nephropathy (T2DN) by comparing it with the glomerular filtration rate (GFR) measured by 99mTc-DTPA method. Methods From June 2010 to January 2011, 76 patients with type 2 diabetes mellitus (T2DM) were classified into two groups according to their 24 h microalbuminuria (m-Alb) level: the normal albuminuric group (n=31) and the microalbuminuric group (n=45). GFR, Serum creatinine (Scr), CysC, and hemoglobin A1c (HbA1c) were measured. Thirty-eight healthy subjects were recruited as the control group, and statistical analysis was carried out. Results The CysC levels in the control group, the normal albuminuric group and the microalbuminuria group were respectively (1.1±0.6), (1.6±0.7) and (1.0±0.3) mg/L, with a significant difference among the three groups (P lt;0.05). HbA1c level in the three groups were respectively (7.1±2.7)%, (7.9±3.1)% and (5.4±0.6)%, with a significant difference between the two diabetic groups and the control group (P lt;0.05). Scr levels in the three groups were respectively (87.7±23.8), (93.7±38.4), (81.5±11.4) μmol/L; GFR levels in the three groups were respectively (80.9±23.0), (74.2±26.1), (79.3±19.7) mL/(min?1.73 m2); among the three groups the differences of both Scr and GFR were not significant. Both CysC and Scr were negatively correlated with GFR (r=-0.694,-0.692;P lt;0.001), and CysC was positively correlated with Scr (r=0.903, P lt;0.001). Conclusion Increased CysC may be an early indicator of incipient diabetic nephropathy, but the diagnostic accuracy of CysC is not superior to that of Scr in distinguishing between mildly and moderately reduced GFR.
引用本文： 史育紅,董延武,顏兵,李俊凌,黃慧. 血清胱抑素C、99mTc-DTPA腎小球?yàn)V過(guò)率和尿微量白蛋白聯(lián)合診斷2型糖尿病腎病. 華西醫(yī)學(xué), 2011, 26(6): 828-830. doi: 復(fù)制
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| 8. | Knight EL, Verhave JC, Spiegelman D, et al. Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement[J]. Kidney Int, 2004, 65(4): 1416-1421. |
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| 12. | Dabla PK. Renal function in diabetic nephropathy[J]. World J Diabetes, 2010, 1(2): 48-56. |
- 1. Danziger J. Importance of low-grade albuminuria [J]. Mayo Clin Proc, 2008, 83(7): 806-812.
- 2. 譚天秩. 臨床核醫(yī)學(xué)[M]. 2版. 北京: 人民衛(wèi)生出版社, 2003: 754-755.
- 3. 曹赟, 曹武松. 腎動(dòng)態(tài)顯像診斷糖尿病腎病的臨床研究近況[J]. 實(shí)用臨床醫(yī)學(xué)雜志, 2010, 14(7): 137-139.
- 4. 李鵬飛, 牟亞汝, 辛穎, 等. 前列腺素E1治療糖尿病腎病1年的隨訪研究[J]. 南方醫(yī)科大學(xué)學(xué)報(bào), 2010, 30(3): 482-485.
- 5. 許曼英, 陸光華, 陳明道. 糖尿病學(xué)[M]. 上海: 上海科學(xué)技術(shù)出版社, 2003: 424.
- 6. Ninomiya T, Perkovic V, de Galan BE, et al. Albuminuria and kidney function independently predict cardiovascular and renal outcomes in diabetes[J]. J Am Soc Nephrol, 2009, 20(8): 1813-1821.
- 7. Kramer CK, Leitão CB, Pinto LC, et al. Clinical and laboratory profile of patients with type 2 diabetes with low glomerular filtration rate and normoalbuminuria[J]. Diabetes Care, 2007, 30(8): 1998-2000.
- 8. Knight EL, Verhave JC, Spiegelman D, et al. Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement[J]. Kidney Int, 2004, 65(4): 1416-1421.
- 9. Oddoze C, Morange S, Portugal H, et al. Cystatin C is not more sensitive than creatinine for detecting early renal impairment in patients with diabetes[J]. Am J Kidney Dis, 2001, 38(2): 310-316.
- 10. Pöge U, Stoschus B, Stoffel-Wagner B, et al. Cystatin C as an endogenous marker of glomerular filtration rate in renal transplant patients[J]. Kidney Blood Press Res, 2003, 26(1): 55-60.
- 11. Daniel JP, Chantrel F, Offner M, et al. Comparison of cystatin C, creatinine and creatinine clearance vs. GFR for detection of renal failure in renal transplant patients[J]. Ren Fail, 2004, 26(3): 253-257.
- 12. Dabla PK. Renal function in diabetic nephropathy[J]. World J Diabetes, 2010, 1(2): 48-56.