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目的探讨血清半胱氨酸蛋白酶抑制剂C(Cys-C)和同型半胱氨酸(HCY)联合检测对儿童糖尿病早期肾损伤的诊断意义。方法将92例糖尿病患儿根据24h尿白蛋白排泄率(UAER)分为3组(B、C、D),其中B组为正常白蛋白尿组(UAER<30mg/24h,33例),C组为微量白蛋白尿组(30mg/24h≤UAER≤300mg/24h,28例),D组为大量白蛋白尿组(UAER>300mg/24h,31例)。选择同期42例正常体检儿童为对照组(A组)。同时测定各组儿童血清胱抑素C(Cys-C)、同型半胱氨酸(HCY)、肌酐(Scr)、尿素氮(BUN)和尿酸(UA)水平,采用Cockroft-Gault公式计算内生肌酐清除率(Ccr),并对各组上述指标进行统计学比对分析。结果糖尿病各组患儿血清Cys-C、HCY、Scr、BUN、UA与对照组比较均升高,同时其水平随UAER的逐渐升高而升高,Ccr与对照组比较则逐渐下降。B、C、D3组中Cys-C、HCY水平与A组比较差异均有统计学意义(P<0.05)。糖尿病各组各项指标两两比较差异均有统计学意义(P<0.05)。血清Cys-C和HCY联合检测的阳性率为76.1%,高于Cys-C和HCY单独检测的阳性率(59.8%、56.5%,P<0.05)。结论血清中Cys-C和HCY是反映早期肾功能损害的灵敏指标,Cys-C和HCY的联合检测可早期反映糖尿病肾损伤的程度。
Objective To investigate the diagnostic value of combined detection of serum cystatin C (Cys-C) and homocysteine (HCY) in early diagnosis of diabetic nephropathy in children. Methods Ninety-two children with diabetes were divided into three groups (B, C, D) according to their urinary albumin excretion rate (UAER). Group B was normal albuminuria group (UAER <30mg / 24h, 33 cases) Group albuminuria (30mg / 24h≤UAER≤300mg / 24h, 28 cases), group D was large albuminuria group (UAER> 300mg / 24h, 31 cases). 42 normal subjects were selected as the control group (A group). The levels of serum Cys-C, HCY, Scr, BUN and UA in each group were also measured. The Cockroft-Gault formula was used to calculate the endogenous Creatinine clearance rate (Ccr), and the above indicators of each group were statistically analyzed. Results The levels of Cys-C, HCY, Scr, BUN and UA in children with diabetes mellitus were significantly higher than those in the control group. The levels of Cys-C, HCY, Scr, BUN and UA were all increased with the increase of UAER. The levels of Cys-C and HCY in group B, C and D3 were significantly different from those in group A (P <0.05). There were significant differences in each index of each group (P <0.05). The positive rate of serum Cys-C and HCY was 76.1%, which was higher than that of Cys-C and HCY (59.8%, 56.5%, P <0.05). Conclusions Cys-C and HCY in serum are sensitive indicators of early renal damage. Combined detection of Cys-C and HCY can early reflect the degree of diabetic renal injury.