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目的利用血肌酐、胱抑素C、血肌酐联合血胱抑素C 3种指标的肌酐有关肾小球滤过率(e GFRCr)、胱抑素有关肾小球滤过率(e GFRCys)和与两者均有关联的e GFRCr-Cys3种公式来比较糖尿病患者肾功能不全发病率,评价e GFR与其相关并发症之间的关联。方法选择2011年至2014年在郑州市第七人民医院治疗的有血胱抑素C、血肌酐结果的患者2 374例,其中男性960例,女性1 414例;年龄12~71岁,平均年龄52.5岁。糖尿病患者有高血压占71%。糖尿病患者体质量指数(BMI)<25 kg/m2、25~30 kg/m2、>30 kg/m2分布分别为14.2%、43.7%、42.1%,非糖尿病患者分别为42.0%、33.1%、24.9%。e GFR=60 m L/(min·1.73 m2)作为肾功能是否下降的分水岭,根据慢性肾脏疾病流行病学协会(CKD-EPI)在2009年、2012年制定的有关血肌酐、血胱抑素C的公式进行估算e GFR。结果糖尿病患者604例,使用e GFRCr、e GFRCys、e GFRCr-Cys3种公式估算肾功能不全的发生率分别为42.4%、56.3%、49.3%。e GFRCr估算e GFR≥60 m L/(min·1.73 m2)患者有部分通过e GFRCys、e GFRCr-Cys公式估算后e GFR<60 m L/(min·1.73 m2),且糖尿病患者较非糖尿病患者更明显。3种公式均显示e GFR与糖尿病相关并发症(蛋白尿、视网膜病变、心血管损害、其他靶器官损害)及全因死亡率呈负相关,且3种公式间差异没有统计学意义。仅e GFRCys、e GFRCr-Cys公式显示e GFR与心血管病死亡率呈负相关。结论在糖尿病人群中,使用e GFRCys或者e GFRCr-Cys联合血肌酐能得到较高的肾功能不全发生率,且与心血管病死亡率密切相关。但使用e GFRCys、e GFRCr-Cys能否应用于临床评价且明显改善糖尿病患者预后需进一步研究。
OBJECTIVE: To evaluate the effects of serum creatinine, cystatin C, creatinine combined with serum cystatin C on glomerular filtration rate (e GFRCr), cystatin-related glomerular filtration rate (e GFRCys) and E GFRCr-Cys 3 formulas that are related to both to compare the incidence of renal insufficiency in diabetic patients and evaluate the association between e GFR and its associated complications. Methods A total of 2 374 patients with serum cystatin C and serum creatinine were enrolled in the Seventh People’s Hospital of Zhengzhou City from 2011 to 2014. Among them, 960 were male and 1 414 were female; the average age was 12-71 years 52.5 years old. Diabetes patients have high blood pressure 71%. Diabetic patients had body mass index (BMI) of 25 kg / m2, 25-30 kg / m2 and> 30 kg / m2 distribution of 14.2%, 43.7% and 42.1%, respectively, and those in non-diabetic patients were 42.0%, 33.1% and 24.9 %. e GFR = 60 m L / (min · 1.73 m2) as a watershed for the decline of renal function. According to the data of CKD-EPI in 2009 and 2012 on serum creatinine, C formula to estimate e GFR. Results Among the 604 patients with diabetes mellitus, the rates of renal insufficiency estimated using the e GFRCr, e GFRCys, e GFRCr-Cys 3 formulas were 42.4%, 56.3% and 49.3%, respectively. eGFRCr estimated e GFR ≥ 60 m L / (min · 1.73 m2) eGFR <60 m L / (min · 1.73 m2) after e GFRCys, e GFRCr-Cys equation was estimated by e GFRCr, and patients with diabetes than non-diabetic Patients are more obvious. All three formulas showed that e GFR was negatively correlated with diabetes-related complications (proteinuria, retinopathy, cardiovascular damage, other target organ damage) and all-cause mortality, and there was no significant difference between the three formulas. Only e GFRCys, e GFRCr-Cys formula showed a negative correlation between e GFR and cardiovascular mortality. Conclusions In patients with diabetes mellitus, the use of e GFRCys or e GFRCr-Cys in combination with serum creatinine results in a higher incidence of renal insufficiency and is closely related to cardiovascular mortality. But the use of e GFRCys, eGFRCr-Cys can be applied to clinical evaluation and significantly improve the prognosis of diabetic patients need further study.