CAJ | 학술논문

目的：探讨血清胱抑素C（Cys-C）对2型糖尿病早期肾损伤的诊断价值。方法将120例2型糖尿病患者按24 h尿微量白蛋白排泄率（UAER）分为3组：单纯性糖尿病组（DM组，UAER＜30 mg·24 h-1）、糖尿病肾病早期组（DN 1组，UAER 30～300 mg·24 h-1）和糖尿病肾病中晚期组（DN 2组，UAER＞300 mg·24 h-1），每组40例。选择体检的健康体检者（对照组）40例。使用全自动生化分析仪、采用胶乳增强免疫透射比浊法检测4组血清Cys-C水平，使用全自动生化分析仪、采用速率法检测血清肌酐（Scr）水平，使用全自动生化分析仪、采用尿素酶法检测血清尿素氮（BUN）水平；使用全自动生化分析仪、采用免疫透射比浊法检测尿微量白蛋白（mALB）水平，并计算24 h尿 UAER，同时进行相关性分析。结果与对照组比较，DN 1组、DN 2组血清 Cys-C、尿 UAER和 DN 2组血清BUN、Scr水平均显著升高（P＜0．05或P＜0．01），DN 2组血清Cys-C、尿 UAER和血清BUN、Scr水平均显著高于DN 1组（P＜0．05或P＜0．01）。DM组、DN 1组和DN 2组血清 Cys-C、尿 UAER和 DN 1组、DN 2组血清BUN及DN 2组血清 Scr阳性率与对照组比较差异均有统计学意义（均P＜0．01），DN 1组、DN 2组血清BUN和DN 2组血清 Scr阳性率与DM组比较差异均有统计学意义（均P＜0．01），DN 2组血清 Scr、Cys-C、尿 U-REA和血清BUN阳性率与DN 1组比较差异均有统计学意义（P＜0．05或P＜0．01）。相关性分析结果显示，120例患者血清Cys-C水平与尿UAER和血清BUN、Scr水平均呈正相关（r＝0．882、0．582和0．655，均P＜0．01）。结论 Cys-C可以作为糖尿病肾病早期的观察指标，具有一定的早期诊断价值，可以弥补单纯微量白蛋白检测引起的漏诊。
목적：탐토혈청광억소C（Cys-C）대2형당뇨병조기신손상적진단개치。방법장120례2형당뇨병환자안24 h뇨미량백단백배설솔（UAER）분위3조：단순성당뇨병조（DM조，UAER＜30 mg·24 h-1）、당뇨병신병조기조（DN 1조，UAER 30～300 mg·24 h-1）화당뇨병신병중만기조（DN 2조，UAER＞300 mg·24 h-1），매조40례。선택체검적건강체검자（대조조）40례。사용전자동생화분석의、채용효유증강면역투사비탁법검측4조혈청Cys-C수평，사용전자동생화분석의、채용속솔법검측혈청기항（Scr）수평，사용전자동생화분석의、채용뇨소매법검측혈청뇨소담（BUN）수평；사용전자동생화분석의、채용면역투사비탁법검측뇨미량백단백（mALB）수평，병계산24 h뇨 UAER，동시진행상관성분석。결과여대조조비교，DN 1조、DN 2조혈청 Cys-C、뇨 UAER화 DN 2조혈청BUN、Scr수평균현저승고（P＜0．05혹P＜0．01），DN 2조혈청Cys-C、뇨 UAER화혈청BUN、Scr수평균현저고우DN 1조（P＜0．05혹P＜0．01）。DM조、DN 1조화DN 2조혈청 Cys-C、뇨 UAER화 DN 1조、DN 2조혈청BUN급DN 2조혈청 Scr양성솔여대조조비교차이균유통계학의의（균P＜0．01），DN 1조、DN 2조혈청BUN화DN 2조혈청 Scr양성솔여DM조비교차이균유통계학의의（균P＜0．01），DN 2조혈청 Scr、Cys-C、뇨 U-REA화혈청BUN양성솔여DN 1조비교차이균유통계학의의（P＜0．05혹P＜0．01）。상관성분석결과현시，120례환자혈청Cys-C수평여뇨UAER화혈청BUN、Scr수평균정정상관（r＝0．882、0．582화0．655，균P＜0．01）。결론 Cys-C가이작위당뇨병신병조기적관찰지표，구유일정적조기진단개치，가이미보단순미량백단백검측인기적루진。
Objective To explore the value of serum cystatin C(Cys-C)in early diagnosis of type 2 diabetic nephropathy.Methods According to 24-hour urinary albumin excretion rate (UAER),120 patients with type 2 diabetes mellitus were divided into simple diabetes mellitus group(DM group,UAER<30 mg · 24 h-1 ),early stage of diabetic nephropathy group (DN 1 group,UAER 30-300 mg·24 h-1 )and advanced diabetic nephropathy group(DN 2 group,UAER>300 mg·24 h-1 ),with 40 patients in each group.In addition,40 healthy subjects were enrolled as the control group.Levels of serum Cys-C,serum creatinine(Scr),blood urea nitrogen(BUN)and urine microalbumin(mALB)were detected by latex enhanced immune transmission turbidimetric method,velocity method,urea enzymatic method and immune transmission turbidimetric method using automatic biochemical analyzer,respectively.Furthermore,24-hour UAER was calculated and correlation analysis was performed.Results Compared with control group,levels of Cys-C and UAER significantly increased in DN 1 group and DN 2 group levels of BUN and Scr signifi-cantly increased in DN 2 group(P<0.05 or P<0.01).Compared with DN 1 group,levels of Cys-C,UAER,BUN and Scr significantly increased in DN 2 group(P<0.05 or P<0.01).Moreover, levels of Cys-C and UAER in DM group and levels of BUN and positive rate of Scr in DN 2 group were significantly different from those in control group(P<0.01).Levels of BUN in DN 1 group and DN 2 group and positive rate of Scr in DN 2 group were significantly different from those in DM group(P<0.01).Levels of Scr,Cys-C and UREA and positive rate of BUN in DN 2 group were significantly different from those in DN 1 group(P<0.05 or P<0.01).The correlative anal-ysis showed that levels of Cys-C were positively correlated with levels of UAER,BUN and Scr in patients with type 2 diabetes mellitus(r=0.882,0.582 and 0.655,respectively;P<0.01).Conclu-sion Cystatin-C can be used as an indicator in early diagnosis of diabetic nephropathy.Cys-C de-tection can redeem the missed diagnosis caused by the simple mALB detection.