目的 探讨血清胱抑素C 在糖尿病肾病(diabetic nephropathy, DN)患者肾小球损害中的诊断价值。方法 选择2012-03至2013-12在火箭军总医院住院治疗的160例2型糖尿病患者作为研究对象,按照尿白蛋白排泄量的不同,将所有患者分为正常白蛋白尿组(70例),微量白蛋白尿组(53例),临床白蛋白尿组(37例)。同时,对3组患者的血清胱抑素C(Cys-c)、尿素氮(BUN)、肌酐(Scr)及糖化血红蛋白(HbAlc)进行检测。结果 微量白蛋白尿组血清Cys-c为(1.56±0.59)mg/L, HbAlc为(8.32±1.58)%; 临床白蛋白尿组中血清Cys-c为(1.79±0.86) mg/L, HbA₁c为(9.46±1.69) %; 正常白蛋白尿组血清Cys-c(0.92±0.21) mg/L,HbA₁c(5.13±1.65) %。微量白蛋白尿组及临床白蛋白尿组均明显高于正常白蛋白尿组(P<0.01)。DN组的Cys-c、BUN及Scr检测的阳性率分别是91.11%、62.22%、68.89%,Cys-c检测结果明显高于BUN和Scr,Cys-c分别与BUN、Scr比较,差异有统计学意义(P<0.05),三组比较差异同样有统计学意义(P<0.05);通过对肾小球滤过功能的分度检测可以看出,将Cys-c作为内源性标志物比BUN和Scr更加敏感,更能敏锐地检测出肾小球的损害。结论 Cys-c、BUN及Scr均为检测DN患者肾小球损害的指标,但Cys-c在诊断早期DN患者肾小球损害上更加敏感,能够直观地体现肾小球滤过功能变化,值得临床方面广泛推广和应用。

Objective To study the clinical value of serum cystatin C levels in determining glomerular damage among patients with diabetic nephropathy.Methods One hundred and sixty type 2 diabetic patients who were hospitalized in PLA Rocket Force General Hospital were selected as subjects. According to the difference of urinary microalbumin(mAlb), these patients were divided into three groups: normal albuminuria group(mAlb<30 mg/24 h, n=70),microalbuminuria group(mAlb 30-300 mg/24 h,n=53) and clinical proteinuria group(mAlb>300 mg/24 h,n=37). Levels of serum cystatin C (Cys-c), blood urea nitrogen (BUN), serum creatinine (Scr) and glycosylated hemoglobin (HbA₁c) in the three groups were monitored,recorded and analyzed.Results The levels of serum Cys-c and HbAlc were (1.56±0.59)mg/L, (8.32±1.58)% respectively in the microalbuminuria group, (1.79±0.86)mg/L, HbAlc(9.46±1.69) % respectively in the clinical proteinuria group,and (0.92±0.21) mg/L,HbA₁c(5.13±1.65) % respectively in the normal albuminuria group. The levels of serum Cys-c and HbA1c in the DN group (microalbuminuria group and clinical proteinuria group) were significantly higher than those in the normal albuminuria group (P<0.05). The positive rates of Cys-c, BUN and Scr in the DN group were 91.11%, 62.22% and 68.89% respectively. The results showed that Cys-c was significantly higher than BUN and Scr, and the difference was statistically significant(P<0.05), so was the difference between the three groups (P<0.05). Cys-c as an endogenous marker was more sensitive than BUN and Scr, for it could help detect glomerular damage.Conclusions Cys-c, BUN and Scr are all indexes of glomerular damage in diabetic nephropathy patients, but Cys-c is more sensitive in the diagnosis of early diabetic nephropathy with glomerular damage, and offers more information on the changes of glomerular filtration function, so it is of clinical value in early diagnosis of diabetic nephropathy.