【摘要】 目的 以99mTc-DTPA肾动态显像法肾小球滤过率（glomerular filtration rate，GFR）测定为标准，将血清胱抑素C（cystatin C， CysC）检测与其比较，探讨CysC测定在2型糖尿病肾病（type 2 diabetic nephropathy，T2DN）诊断中的意义。 方法 2010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（serum creatinine， Scr）和糖化血红蛋白（hemoglobin A1c， 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（P lt;0.05）；HbA1c水平分别为（5.4±0.6）%、（7.1±2.7）%、（7.9±3.1）%、两组T2DM患者与对照组比较，差异均有统计学意义（P lt;0.05）；GFR水平分别为（80.9±23.0）、（74.2±26.1）、（79.3±19.7） mL/（min•1.73 m2），各组差异无统计学意义（P gt;0.05）；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 gt;0.05）。CysC、Scr和GFR之间呈负相关（r=-0.694，-0.692；P lt;0.001）；CysC和Scr之间呈正相关（r=0.903，P lt;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 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.
Citation：
SHI Yuhong,DONG Yanwu,YAN Bing,LI Junling,HUANG Hui. Combined Measurement of Serum Cystatin C, 99mTc-DTPA and Urine Microalbumin in Early Diagnosis of Type 2 Diabetic Nephropathy. West China Medical Journal, 2011, 26(6): 828-830. doi:
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Copyright © the editorial department of West China Medical Journal of West China Medical Publisher. All rights reserved
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Danziger J. Importance of low-grade albuminuria [J]. Mayo Clin Proc, 2008, 83(7): 806-812.
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谭天秩. 临床核医学[M]. 2版. 北京: 人民卫生出版社, 2003: 754-755.
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曹赟, 曹武松. 肾动态显像诊断糖尿病肾病的临床研究近况[J]. 实用临床医学杂志, 2010, 14(7): 137-139.
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李鹏飞, 牟亚汝, 辛颖, 等. 前列腺素E1治疗糖尿病肾病1年的随访研究[J]. 南方医科大学学报, 2010, 30(3): 482-485.
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许曼英, 陆光华, 陈明道. 糖尿病学[M]. 上海: 上海科学技术出版社, 2003: 424.
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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.
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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.
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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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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.
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| 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.
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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. 谭天秩. 临床核医学[M]. 2版. 北京: 人民卫生出版社, 2003: 754-755.
- 3. 曹赟, 曹武松. 肾动态显像诊断糖尿病肾病的临床研究近况[J]. 实用临床医学杂志, 2010, 14(7): 137-139.
- 4. 李鹏飞, 牟亚汝, 辛颖, 等. 前列腺素E1治疗糖尿病肾病1年的随访研究[J]. 南方医科大学学报, 2010, 30(3): 482-485.
- 5. 许曼英, 陆光华, 陈明道. 糖尿病学[M]. 上海: 上海科学技术出版社, 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.
