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目的探讨联合检测血清C反应蛋白(CRP)和胱抑素C(CysC)对糖尿病早期肾损害的诊断价值。方法据24h尿微量白蛋白排出量将88例2型糖尿病患者分为三组,即正常白蛋白尿组(A组,尿白蛋白<30mg/24h),微量白蛋白尿组(B组,尿白蛋白30~300mg/24h),大量白蛋白尿组(C组,尿白蛋白>300mg/24h);另选门诊健康体检者20例作为健康对照组(N组)。检测各组血清CysC、CRP、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、血压收缩压(SBP)、舒张压(DBP)、体重指数(BMI)、甘油三酯(TG)、胆固醇(TC)、尿素(BUN)、肌酐(SCr),并且计算内生肌酐清除率(CCR)。结果与正常蛋白尿组比较,微量和大量白蛋白尿组血Cysc明显升高,差异有统计学意义(P<0.01或P<0.05),大量白蛋白尿组较微量白蛋白尿组Cysc也明显升高(P<0.05);三组糖尿病患者血清CRP水平与正常对照组比较,显著升高,差异有统计学意义(P<0.01),随着尿蛋白的增多而升高;CysC与CCR呈负相关(r=-0.417,P<0.05),与BUN,Cr、CRP呈正相关(r=0.318,0.393,0.405),均有统计学意义(P<0.05)。结论 CysC水平可以敏感地反应糖尿病肾脏损害的发生,联合检测CRP与Cysc对糖尿病肾病的早期诊断具有重要的临床意义。
Objective To investigate the value of combined detection of serum C-reactive protein (CRP) and cystatin C (CysC) in the diagnosis of early diabetic nephropathy. Methods According to the excretion of 24h urinary albumin, 88 type 2 diabetic patients were divided into three groups: normal albuminuria group (A group, urinary albumin <30mg / 24h), microalbuminuria group (B group, urine Albumin 30 ~ 300mg / 24h), a large amount of albuminuria group (C group, urinary albumin> 300mg / 24h); another 20 healthy subjects were selected as healthy control group (N group). The levels of CysC, CRP, FBG, HbA1c, SBP, DBP, BMI, TG, , Urea (BUN), creatinine (SCr), and calculated endogenous creatinine clearance (CCR). Results Compared with the normal proteinuria group, the serum levels of Cysc in microalbuminuria and macroalbuminuria groups were significantly increased (P <0.01 or P <0.05), and those in microalbuminuria group were significantly higher than those in microalbuminuria group (P <0.05). The levels of serum CRP in the three groups of diabetic patients were significantly higher than those in the normal control group (P <0.01), and increased with the increase of urinary protein. The levels of CysC and CCR (R = -0.417, P <0.05), but positively correlated with BUN, Cr, CRP (r = 0.318,0.393,0.405), all of which were statistically significant (P <0.05). Conclusion CysC level can sensitively reflect the occurrence of diabetic nephropathy. Combined detection of CRP and Cysc has an important clinical significance in the early diagnosis of diabetic nephropathy.