吉林大学学报(医学版) ›› 2015, Vol. 41 ›› Issue (05): 998-1003.doi: 10.13481/j.1671-587x.20150522

• 临床研究 • 上一篇    下一篇

2型糖尿病肾病患者血清胱抑素C和同型半胱氨酸水平的检测及其临床意义

张研1, 崔巍2, 温言1, 王清1   

  1. 1. 吉林大学中日联谊医院内分泌科, 吉林 长春 130033;
    2. 吉林省白山市中心医院干部疗区, 吉林 白山 134300
  • 收稿日期:2014-11-13 出版日期:2015-09-28 发布日期:2015-09-29
  • 通讯作者: 王清,教授,博士研究生导师(Tel:0431-84995198,E-mail:wangqing5151@126.com) E-mail:wangqing5151@126.com
  • 作者简介:张研(1978-),女,湖北省荆州市人,主治医师,医学博士,主要从事糖尿病发病机制及治疗方面的研究。
  • 基金资助:

    吉林省科技厅科技发展计划项目资助课题(20110464)

Assay of levels of serum cystatin C and homocysteine in patients with type 2 diabetic nephropathy and their clinical significances

ZHANG Yan1, CUI Wei2, WEN Yan1, WANG Qing1   

  1. 1. Department of Endocrinology, China-Japan Union Hospital, Jilin University, Changchun 130033, China;
    2. Cadre Wards, Baishan Central Hospital, Jilin Province, Baishan 134300, China
  • Received:2014-11-13 Online:2015-09-28 Published:2015-09-29

摘要:

目的:探讨2型糖尿病肾病(DN)患者血清胱抑素C(Cys C)和同型半胱氨酸(Hcy)水平,阐明其临床意义。方法:选取100例2型糖尿病(T2DM)患者,按Mogenson分期分为单纯糖尿病组(DM组,n=32)、早期DN组(EDN组,n=40)和临床DN组(CDN组,n=28),并设对照组(n=20)。全自动生化分析仪测定研究对象糖化血红蛋白(HbA1C)、血生化指标、Cys C水平和尿微量白蛋白排泄率(UAER);循环酶法测定研究对象Hcy水平,计算肾小球滤过率(GFR)和内生肌酐清除率(Ccr);所有受试者测量体质量、身高、腰围、舒张压(DBP)和收缩压(SBP);相关分析法分析Cys C、Hcy和UAER的影响因素;比较各组患者中Cys C、Hcy和UAER的阳性检出率。结果:随T2DM病程延长,患者SBP、HbA1c和TC水平逐渐升高,明显高于对照组(P<0.05)。患者肾功能UAER、BUN、Scr、Cys C和Hcy水平逐渐升高。DM组患者UAER、BUN和Hcy水平高于对照组(P<0.05);EDN组患者UAER、BUN、Cys C和Hcy水平高于对照组(P<0.05),仅UAER、Cys C和Hcy水平高于DM组(P<0.05);与EDN组比较,CDN组患者UAER、BUN、SCr、CysC和Hcy水平升高(P<0.05);与对照组比较,DM组患者UAER、BUN、Scr、Cys C和Hcy水平升高(P<0.05)。糖尿病各组患者Ccr和GFR呈逐渐下降趋势,其中CDN组患者Ccr和GFR水平低于对照组、DM组和END组(P<0.05)。相关分析检测,血清Cys C水平与病程和UAER、Hcy、Scr、BUN、HbA1c、SBP水平呈正相关关系(r=0.61,r=0.804,r=0.597,r=0.516,r=0.487,r=0.423,r=0.359,P<0.01),与GFR和Ccr呈负相关关系(r=-0.652,r=-0.589,P<0.01);Hcy水平与病程和UAER、Scr、BUN、HbA1c及SBP水平呈正相关关系(r=0.673,r=0.784,r=0.502,r=0.396,r=0.416,r=0.209,P<0.01),与GFR、Ccr呈负相关关系(r=-0.623,r=-0.647,P<0.01)。偏相关分析检测,UAER与 Cys C相关程度高(r=0.789,P<0.01),与Hcy相关程度明显(r=0.697,P<0.01),与Scr和BUN 相关程度一般(r=0.472,r=0.543,P<0.01)。EDN组患者Cys C和Hcy阳性检出率明显高于血清Scr、BUN阳性检出率(P<0.05)。结论:血清Cys C和Hcy均能够反映早期肾损伤,Cys C敏感性更高,具有早期诊断DN和作为肾损伤标志物的临床价值;血清Cys C联合Hcy检测可监测DN患者肾功能和评估预后。

关键词: 胱抑素C, 同型半胱氨酸, 糖尿病肾病, 糖尿病, 2型

Abstract:

Objective To investigate the levels of serum cystatin C(Cys C)and homocysteine (Hcy) in the patients with type 2 diabetic nephropathy(DN), and to clarify their clinical significances. Methods 100 patients of type 2 diabetes mellitus(T2DM) were divided into three groups according to Mogenson staging: simple diabetes mellitus group(DM,n=32),early DN group (EDN,n=40),clinical DN group(CDN,n=28).The healthy subjects were defined as control group(n=20).The following variables were detected by automatic biochemical analyzer:HbA1c,serum biochemistry indexes,Cys C and urinary albumin excretion rate(UAER);the serum Hcy level was measured by circulate enzymatic determination method;the glomerular filter rate (GFR) and endogenous muscle liver clear rate (Ccr) was calculated;the indexes of weight,height,waist circumference,DBP,SBP of all subjects were measured;the influence factors of Cys C,Hcy, and UAER were analyzed by correlation analysis;the positive rates of Cys C,Hcy, and UAER were detected in various groups. Results As the extension of T2DM duration,compared with control group,the levels of SBP,HbA1c,and TC of the diabetic subjects were increased significantly (P<0.05).The levels of UAER,BUN,Scr,Cys C,and Hcy were gradually increased of the patients in diabetes groups.The levels of UAER,BUN, and Hcy of the patients in DM group were higher than those in control group(P<0.05);the levels of UAER,BUN,Cys C and Hcy of the patients in EDM group were higher than those in control group(P<0.05),and the levels of UAER,Cys C,and Hcy were significantly increased compared with DM group(P<0.05);compared with EDN group,the levels of UAER,BUN,Scr,Cys C, and Hcy of the patients in CDN group were increased(P<0.05);compared with control group,the levels of UAER,BUN,Scr,Cys C, and Hcy of the patients in DM group were increased(P<0.05);the levels of GFR and Ccr of the patients in DM group were gradually decreased,and were higher than those in control,DM,and EDN groups(P<0.05).The correlation analysis results showed that the serum Cys C level was positively correlated with diabetes duration,UAER,Hcy,Scr,BUN,HbA1c and SBP(r=0.61,r=0.804,r=0.597,r=0.516,r=0.487,r=0.423,r=0.359,P<0.01),and negatively correlated with GFR and Ccr(r=-0.652,r=-0.589,P<0.01);the level of Hcy was positively correlated with diabetes duration,UAER,Scr,BUN,HbA1c and SBP(r=0.673,r=0.784,r=0.502,r=0.396,r=0.416,r=0.209,P<0.01),and negatively correlated with GFR and Ccr(r=-0.623,r=-0.647,P<0.01).The partial correlation analysis results showed that UAER had the most significant relationship with Cys C(r=0.789,P<0.05),then with Hcy(r=0.697,P<0.05),and had general relationship with Scr and BUN (r=0.472,r=0.543,P<0.05).The positive rates of Cys C and Hcy of the patients were higher than the positive rates of Scr and BUN in EDN group(P<0.05). Conclusion Both of serum Cys C and Hcy are able to reflect early renal damage.Cys C is more sensitivity and has clinical value in early diagnosis of DN and being a kidney injury marker.Joint detection of serum Cys C and Hcy can evaluate the renal function and prognosis of DN patients.

Key words: cystatin C, homocysteine, diabetic nephropathy, diabetes mellitus,type 2

中图分类号: 

  • R587.1