血清胱抑素C、99mTc-DTPA肾小球滤过率和尿微量白蛋白联合诊断2型糖尿病肾病

【】　目的　以99mTc-DTPA肾动态显像法肾小球滤过率（glomerularfiltrationrate，GFR）测定为标准，将血清胱抑素C（cystatinC，CysC）检测与其比较，探讨CysC测定在2型糖尿病肾病（type2diabeticnephropathy，T2DN）诊断中的意义。　方法　2010年6月―2011年1月76例2型糖尿病（type2diabetesmellitus，T2DM）患者按24h尿微量白蛋白（microalbuminuria，m-Alb）分为两组正常蛋白尿组（31例）和微量蛋白尿组（45例），同时测定GFR、CysC、血清肌酐（serumcreatinine，Scr）和糖化血红蛋白（hemoglobinA1c，HbA1c），并设正常自愿者38名作为对照组，进行统计学分析。　结果　对照组、T2DM正常蛋白尿组及T2DM微量蛋白尿组CysC水平分别为（1.1±0.6）、（1.6±0.7）、（1.0±0.3）mg/L，各组差异均有统计学意义（P0.05）；Scr水平分别为（87.7±23.8）、（93.7±38.4）、（81.5±11.4）μmol/L，组间差异无统计学意义（P>0.05）。CysC、Scr和GFR之间呈负相关（r=-0.694，-0.692；P<0.001）；CysC和Scr之间呈正相关（r=0.903，P<0.001）。　结论　CysC可作为早期T2DN的检测指标，具有较高的敏感性，但对于轻度到中度GFR降低的诊断准确性并不优于Scr。【Abstract】　Objective　Todemonstratetheclinicalvalueofserumcystatin-C(CysC)intheassessmentofrenalfunctionintype-2diabeticnephropathy(T2DN)bycomparingitwiththeglomerularfiltrationrate(GFR)measuredby99mTc-DTPAmethod.　Methods　FromJune2010toJanuary2011,76patientswithtype2diabetesmellitus(T2DM)wereclassifiedintotwogroupsaccordingtotheir24hmicroalbuminuria(m-Alb)levelthenormalalbuminuricgroup(n=31)andthemicroalbuminuricgroup(n=45).GFR,Serumcreatinine(Scr),CysC,andhemoglobinA1c(HbA1c)weremeasured.Thirty-eighthealthysubjectswererecruitedasthecontrolgroup,andstatisticalanalysiswascarriedout.　Results　TheCysClevelsinthecontrolgroup,thenormalalbuminuricgroupandthemicroalbuminuriagroupwererespectively(1.1±0.6),(1.6±0.7)and(1.0±0.3)mg/L,withasignificantdifferenceamongthethreegroups(P<0.05).HbA1clevelinthethreegroupswererespectively(7.1±2.7)%,(7.9±3.1)%and(5.4±0.6)%,withasignificantdifferencebetweenthetwodiabeticgroupsandthecontrolgroup(P<0.05).Scrlevelsinthethreegroupswererespectively(87.7±23.8),(93.7±38.4),(81.5±11.4)μmol/L;GFRlevelsinthethreegroupswererespectively(80.9±23.0),(74.2±26.1),(79.3±19.7)mL/(min?1.73m2);amongthethreegroupsthedifferencesofbothScrandGFRwerenotsignificant.BothCysCandScrwerenegativelycorrelatedwithGFR(r=-0.694,-0.692;P<0.001),andCysCwaspositivelycorrelatedwithScr(r=0.903,P<0.001).　Conclusion　IncreasedCysCmaybeanearlyindicatorofincipientdiabeticnephropathy,butthediagnosticaccuracyofCysCisnotsuperiortothatofScrindistinguishingbetweenmildlyandmoderatelyreducedGFR.