CAJ | 학술논문

目的：探讨血清胱抑素 C(cystatin C,Cys C)、β2微球蛋白(β2-microglobulin,β2-MG)联合检测对慢性肾脏病早期的诊断价值。方法收集2013年1月至2014年10月在本院就诊的高血压患者228例和健康体检者(健康对照组)51例,测定血清中 Cys C、β2-MG 和血肌酐(SCr)3项指标的水平。根据简化肾脏疾病膳食改良试验公式计算的肾小球滤过率(glomerular filtration rate,GFR)将高血压患者分为 A 组(高血压肾病代偿期,80例),B 组(高血压肾病早期,70例),C 组(高血压肾病中期,52例),D 组(高血压肾病晚期,26例)。分析3项指标在各组间的差异及其联合测定对慢性肾脏病早期的敏感性。结果A 组与健康对照组比较,3项指标均值水平均无统计学差异。与健康对照组比较,B、C、D 组血清 Cys C 与β2-MG 均值水平均增高,有统计学差异(P <0.01),而 B 组 SCr 均值水平无明显变化,C、D 组 SCr 均值水平有统计学差异(P <0.01)。3项指标均值水平伴随高血压肾病严重程度均呈逐渐升高趋势。ROC 曲线分析 Cys C、β2-MG、SCr 对高血压肾病诊断的 AUC 值依次为0.879、0.881、0.967。各组指标阳性率分析显示,3项联合检测阳性率大于 Cys C 联合β2-MG,组合阳性率大于单项检测阳性率。相关性分析 Cys C、β2-MG、SCr 与 GFR 之间呈负相关,相关系数 r分别为-0.776,-0.742,-0.732(P <0.01),3项指标之间有较好的相关性,Cys C 与β2-MG 相关性最好(r=0.912)。结论血清 Cys C 与β2-MG 均可作为高血压肾病早期诊断的重要指标,二者联合测定可以提高对高血压早期肾损伤诊断的敏感度,定期联合检测血清 Cys C、β2-MG 和 SCr 水平对高血压肾病的分期诊断及其治疗具有重要指导意义。
목적：탐토혈청광억소 C(cystatin C,Cys C)、β2미구단백(β2-microglobulin,β2-MG)연합검측대만성신장병조기적진단개치。방법수집2013년1월지2014년10월재본원취진적고혈압환자228례화건강체검자(건강대조조)51례,측정혈청중 Cys C、β2-MG 화혈기항(SCr)3항지표적수평。근거간화신장질병선식개량시험공식계산적신소구려과솔(glomerular filtration rate,GFR)장고혈압환자분위 A 조(고혈압신병대상기,80례),B 조(고혈압신병조기,70례),C 조(고혈압신병중기,52례),D 조(고혈압신병만기,26례)。분석3항지표재각조간적차이급기연합측정대만성신장병조기적민감성。결과A 조여건강대조조비교,3항지표균치수평균무통계학차이。여건강대조조비교,B、C、D 조혈청 Cys C 여β2-MG 균치수평균증고,유통계학차이(P <0.01),이 B 조 SCr 균치수평무명현변화,C、D 조 SCr 균치수평유통계학차이(P <0.01)。3항지표균치수평반수고혈압신병엄중정도균정축점승고추세。ROC 곡선분석 Cys C、β2-MG、SCr 대고혈압신병진단적 AUC 치의차위0.879、0.881、0.967。각조지표양성솔분석현시,3항연합검측양성솔대우 Cys C 연합β2-MG,조합양성솔대우단항검측양성솔。상관성분석 Cys C、β2-MG、SCr 여 GFR 지간정부상관,상관계수 r분별위-0.776,-0.742,-0.732(P <0.01),3항지표지간유교호적상관성,Cys C 여β2-MG 상관성최호(r=0.912)。결론혈청 Cys C 여β2-MG 균가작위고혈압신병조기진단적중요지표,이자연합측정가이제고대고혈압조기신손상진단적민감도,정기연합검측혈청 Cys C、β2-MG 화 SCr 수평대고혈압신병적분기진단급기치료구유중요지도의의。
Objective To study the clinical value of combined detection of serum cystatin C andβ2-microglobulin in the diagnosis of hypertensive nephropathy.Methods 228 hypertensive patients and 5 1 normal controls from Jan.2013 to Oct.2014 were selected.According to the glomerular filtration rate calculated by the simplified MDRD formula,228 hypertensive patients were divided into four groups:group A(simple hypertension),group B(hypertensive nephropathy of stage Ⅰ),group C(hy-pertensive nephropathy of stage Ⅱ),and group D(hypertensive nephropathy of stage Ⅲ-Ⅳ).The se-rum levels of Cys C,β2-MG and SCr were determined and compared among the groups.Results There was no significant difference in the serum levels of Cys C,β2-MG and SCr between control group and group A.The serum levels of Cys C and β2-MG were increased in groups B,C and D as compared with control group(P <0.01).The serum SCr level showed no significant difference between control group and group B,but higher in groups C and D than in control group(P <0.01).The serum levels of Cys C,β2-MG and SCr showed a rising trend with the severity of hypertensive nephropathy.ROC curves showed that the AUC of Cys C,β2-MG and SCr in hypertensive nephropathy patients was 0.879,0.881 and 0.967 respectively.In each group,the positive rate of the combined detection of three indicators was higher than that of the combined detection of Cys C andβ2-MG,and the positive rate was higher than that of single detection.Correlation analysis showed a negative correlation be-tween GFR and Cys C,β2-MG,SCr with the correlation coefficient being -0.776,-0.742,and-0.732 respectively(P <0.01).There was strong better correlation between Cys C and β2-MG with the correlation coefficient being 0.912(P <0.01).Conclusions The serum levels of Cys C andβ2-MG could be used as important indicators to judge hypertensive nephropathy.Combined detection of Cys C and β2-MG could improve the sensitivity of the diagnosis for early hypertensive nephropathy,and it was an important clinical value to diagnose and treat hypertensive nephropathy accurately through combined determination of the serum levels of Cys C,β2-MG and SCr regularly.