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目的:研究糖尿病肾病(DN)患者血清同型半胱氨酸(HCY)、胱抑素C(Cys-C)、α1-微球蛋白(α1-MG)、可溶性血栓调节蛋白(sTM)及C反应蛋白(CRP)等5项诊断指标的变化及其诊断价值。方法:将292例糖尿病患者(DM组)分为单纯性糖尿病组(SDM组)95例,早期糖尿病肾病组(EDN组)98例,临床糖尿病肾病组(CDN组)99例,与健康对照组(102例)平行检测上述5项指标。结果:DM组各项指标水平明显高于健康对照组(P<0.01)。糖尿病肾病组(DN)血清5项指标水平组间存在显著差异(P<0.01)。并且随着DN病情进展,各项指标随着24 h尿蛋白排泄率(UAER)的增加逐渐增高(P<0.01),且互相之间关系密切,表明其升高与DN的发生、发展密切相关。在DM患者的病情发展过程中,HCY、Cys-C、α1-MG、STM、CRP最早出现,可为疾病的早期诊断提供数据。结论:血清HCY、CYS-C、α1-MG水平可作为DN早期肾损伤的反应肾小球滤过功能的敏感指标;STM反映高HCY水平的DN患者的微血管损伤程度;CRP与DN患者病情正相关,可作为DN患者病情检测新指标,5项联合检测可提高检出敏感性及阳性率,全面协助DN肾损伤的早期诊断。
Objective: To investigate the changes of serum homocysteine (HCY), cystatin C (Cys-C), α1-microglobulin (α1-MG), soluble thrombomodulin (sTM) and C in patients with diabetic nephropathy Protein (CRP) and other five diagnostic indicators and their diagnostic value. Methods: A total of 292 diabetic patients (DM group) were divided into 95 cases of SDM group, 98 cases of early diabetic nephropathy group (EDN group) and 99 cases of diabetic nephropathy group (CDN group) (102 cases) parallel detection of the above five indicators. Results: The indexes of DM group were significantly higher than those of healthy control group (P <0.01). Diabetic nephropathy group (DN) serum 5 index levels were significantly different (P <0.01). And with the progression of DN, the indexes increased with the increase of 24 h urinary protein excretion (UAER) (P <0.01), and closely related to each other, indicating that the increase is closely related to the occurrence and development of DN . HCY, Cys-C, α1-MG, STM and CRP were the first to be found in the progression of the disease in DM patients, which could provide data for the early diagnosis of the disease. Conclusion: Serum levels of HCY, CYS-C and α1-MG may be used as sensitive indicators of glomerular filtration rate in early renal injury induced by DN. The extent of microvascular damage in DN patients with high HCY level is reflected by STM. Related, can be used as a new indicator of disease detection in patients with DN, 5 joint detection can increase the detection sensitivity and positive rate, to fully assist DN early diagnosis of kidney injury.