【摘要】 目的 以99mTc-DTPA腎動態(tài)顯像法腎小球濾過率（glomerular filtration rate，GFR）測定為標(biāo)準(zhǔn)，將血清胱抑素C（cystatin C， CysC）檢測與其比較，探討CysC測定在2型糖尿病腎?。╰ype 2 diabetic nephropathy，T2DN）診斷中的意義?！》椒ā?010年6月—2011年1月76例2型糖尿病（type 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），同時測定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名作為對照組，進(jìn)行統(tǒng)計學(xué)分析?！〗Y(jié)果 對照組、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)計學(xué)意義（Plt;0.05）；HbA1c水平分別為（5.4±0.6）%、（7.1±2.7）%、（7.9±3.1）%、兩組T2DM患者與對照組比較，差異均有統(tǒng)計學(xué)意義（Plt;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），各組差異無統(tǒng)計學(xué)意義（Pgt;0.05）；Scr水平分別為（87.7±23.8）、（93.7±38.4）、（81.5±11.4） μmol/L，組間差異無統(tǒng)計學(xué)意義（Pgt;0.05）。CysC、Scr和GFR之間呈負(fù)相關(guān)（r=-0.694，-0.692；Plt;0.001）；CysC和Scr之間呈正相關(guān)（r=0.903，Plt;0.001）?！〗Y(jié)論 CysC可作為早期T2DN的檢測指標(biāo)，具有較高的敏感性，但對于輕度到中度GFR降低的診斷準(zhǔn)確性并不優(yōu)于Scr?！続bstract】 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 (Plt;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 (Plt;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;Plt;0.001), and CysC was positively correlated with Scr (r=0.903, Plt;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.
目的分析急性 A 型主動脈夾層患者的甲狀腺功能水平，并探索其臨床意義。方法納入 2018 年 1 月至 2018 年 8 月間于北京安貞醫(yī)院行手術(shù)治療的主動脈 A 型夾層患者 88 例作為試驗組。同時納入 187 名健康成年人作為對照組（對照組參與者基本信息及血液標(biāo)本來源于北京心血管精準(zhǔn)醫(yī)療實驗室）。檢測夾層患者術(shù)前及健康人甲狀腺功能水平同時檢測夾層患者術(shù)前血清肌酐水平?；趭A層患者與健康人之間甲功水平的差異，將夾層患者分為甲狀腺激素水平異常亞組及正常對照亞組，分析夾層患者甲功水平與患者圍術(shù)期血清肌酐的關(guān)系。結(jié)果急性 A 型主動脈夾層患者相比健康人而言，三碘甲狀腺原氨酸總量（TT3）、促甲狀腺素（TSH）以及游離三碘甲狀腺原氨酸（FT3）水平更低，游離甲狀腺素（FT4）水平更高（P<0.001，P<0.001，P<0.001）。同時結(jié)果顯示，術(shù)前低 TT3 水平的夾層患者術(shù)后有較高的血清肌酐水平的增高，急性腎損傷發(fā)生率也明顯增高。結(jié)論急性 A 型主動脈夾層患者較健康正常人表現(xiàn)出明顯的甲狀腺功能水平異常，相關(guān)患者術(shù)前 TT3 水平與患者術(shù)后血清肌酐水平及急性腎損傷相關(guān)。對于急性 A 型主動脈夾層患者，甲功檢測應(yīng)作為術(shù)前常規(guī)檢測。