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目的以99mTc-DTPA肾动态显像法肾小球滤过率(glomerular filtration rate,GFR)测定为标准,将血清胱抑素C(cystatin C,CysC)检测与其比较,探讨CysC测定在2型糖尿病肾病(type 2diabetic nephropathy,T2DN)诊断中的意义。方法 2010年6月～2011年1月76例2型糖尿病(type 2diabetes mellitus,T2DM)患者按24h尿微量白蛋白(microalbuminuria,m-Alb)分为两组:正常蛋白尿组(31例)和微量蛋白尿组(45例),同时测定GFR、CysC、血清肌酐(serum creatinine,Scr)和糖化血红蛋白(hemoglobin A1c,HbA1c),并设正常自愿者38名作为对照组,进行统计学分析。结果对照组、T2DM正常蛋白尿组及T2DM微量蛋白尿组CysC水平分别为(1.1±0.6)、(1.6±0.7)、(1.0±0.3)mg/L,各组差异均有统计学意义(P<0.05);HbA1c水平分别为(5.4±0.6)%、(7.1±2.7)%、(7.9±3.1)%、两组T2DM患者与对照组比较,差异均有统计学意义(P<0.05);GFR水平分别为(80.9±23.0)、(74.2±26.1)、(79.3±19.7)mL/(min.1.73m2),各组差异无统计学意义(P>0.05);Scr水平分别为(87.7±23.8)、(93.7±38.4)、(81.5±11.4)μmol/L,组间差异无统计学意义(P>0.05)。CysC、Scr和GFR之间呈负相关(r=-0.694,-0.692;P<0.001);CysC和Scr之间呈正相关(r=0.903,P<0.001)。结论 CysC可作为早期T2DN的检测指标,具有较高的敏感性,但对于轻度到中度GFR降低的诊断准确性并不优于Scr。
Objective To compare the detection of cystatin C (CysC) with glomerular filtration rate (GFR) by 99mTc-DTPA renal dynamic imaging, and to explore the relationship between CysC and type 2 diabetes mellitus The significance of diagnosis of type 2 diabetic nephropathy (T2DN). Methods From June 2010 to January 2011, 76 patients with type 2 diabetes mellitus (T2DM) were divided into two groups according to the microalbuminuria (m-Alb): normal proteinuria group (31 cases) and Microalbuminuria group (45 cases). Simultaneously, GFR, CysC, serum creatinine (Scr) and hemoglobin A1c (HbA1c) were determined. 38 normal volunteers were selected as the control group for statistical analysis. Results The CysC levels in control group, T2DM normal proteinuria group and T2DM microproteinuria group were (1.1 ± 0.6), (1.6 ± 0.7) and (1.0 ± 0.3) mg / L, respectively (P <0.05). The levels of HbA1c were (5.4 ± 0.6)% and (7.1 ± 2.7)% and (7.9 ± 3.1)%, respectively. There was significant difference between the two groups in T2DM patients and the control group (P <0.05). The levels of GFR were (80.9 ± 23.0), (74.2 ± 26.1) and (79.3 ± 19.7) mL / (min.1.73m2), respectively. There was no significant difference between the groups (P> 0.05) 23.8), (93.7 ± 38.4) and (81.5 ± 11.4) μmol / L, respectively. There was no significant difference between the two groups (P> 0.05). There was a negative correlation between CysC, Scr and GFR (r = -0.694, -0.692; P <0.001). There was a positive correlation between CysC and Scr (r = 0.903, P <0.001). Conclusion CysC can be used as an early detection index of T2DN, which has higher sensitivity. However, the diagnostic accuracy of mild to moderate GFR is not superior to that of Scr.