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目的探讨胱抑素C(Cys-C)作为2型糖尿病(T2DM)肾病分期指标的应用价值。方法测定137例T2DM患者血肌酐(SCr)、Cys-C和24-h尿微量白蛋白排泄率(UAER)。运用MDRD公式计算肾小球滤过率(GFR)。将患者分为三组:GFR>120ml.min-1.1.73m-2为A组,GFR60～120ml.min-1.1.73m-2为B组,GFR<60ml.min-1.1.73m-2为C组。绘制散点图,比较三组Cys-C和UAER的数值及与GFR的相关性。结果C组SCr和24-hUAER高于A组[(102.41±10.72)μmol/Lvs.(42.73±3.99)μmol/L和(303.90±173.66)mgvs.(164.10±114.25)mg];A组Cys-C值明显低于B、C组[(0.47±0.21)mg/Lvs.(0.68±0.13)mg/L、(1.59±0.58)mg/L)]。UAER和Cys-C与GFR的相关系数分别为-0.132和-0.552(P<0.01)。ROC分析提示,Cys-C和UAER的曲线下面积(AUC)分别为0.885和0.605(P<0.05)。结论Cys-C能很好的反映T2DM肾病肾小球滤过功能异常,与临床分期的对应性、诊断特异性和灵敏性都优于UAER。
Objective To investigate the value of cystatin C (Cys-C) as a staging index for type 2 diabetes mellitus (T2DM) nephropathy. Methods Serum creatinine (SCr), Cys-C and 24-h urinary albumin excretion (UAER) were measured in 137 T2DM patients. Glomerular filtration rate (GFR) was calculated using the MDRD formula. The patients were divided into three groups: GFR> 120ml.min-1.1.73m-2 group A, GFR60-120ml.min-1.1.73m-2 group B, GFR <60ml.min-1.1.73m- group. Scatter plots were drawn to compare the values of three groups of Cys-C and UAER with the correlation with GFR. Results The levels of SCr and 24-hUAER in group C were significantly higher than those in group A [(102.41 ± 10.72) μmol / L vs (42.73 ± 3.99) μmol / L and (303.90 ± 173.66) mgvs. C was significantly lower than that of B and C [(0.47 ± 0.21) mg / L vs (0.68 ± 0.13) mg / L, (1.59 ± 0.58) mg / L)]. The correlation coefficients of UAER, Cys-C and GFR were -0.132 and -0.552, respectively (P <0.01). ROC analysis suggested that the area under the curve (AUC) for Cys-C and UAER was 0.885 and 0.605, respectively (P <0.05). Conclusion Cys-C can well reflect the glomerular filtration dysfunction in T2DM nephropathy, which has better diagnostic accuracy and sensitivity than UAER in clinical staging.