胱抑素C在早期肾脏疾病诊断中的价值.docx

胱抑素C在早期肾脏疾病诊断中的价值王永红 姜埃利[通讯作者] 苏海华 张婷 张家隆作者单位：1. 天津医科大学第二医院 300211 2. 海洋石油总医院肾内科300452通讯作者单位: 天津医科大学第二医院 300211摘要　①目的　探讨早期慢性肾脏疾病与血清胱抑素C（Cys-C）之间的关系。②方法 应用放射性核素标记物99mTc-DTPA测定慢性肾脏疾病患者的肾小球滤过率（GFR）。选取GFR＞30ml/min的67例患者作为CKD组，根据GFR结果将患者分为CKD1期组、CKD2期组、CKD3期组三个亚组。全部患者检测血清胱抑素C（Cys-C）、同型半胱氨酸（Hcy）、血肌酐（Scr）、尿素氮（BUN）、内生肌酐清除率（Ccr）、尿微量白蛋白（M-ALB）等指标，同时选取20例健康受试组作为对照组。对比CKD组和对照组以及CKD亚组间Scr、Ccr、Hcy、Cys-C、M-ALB的变化。③结果 实验组Cys-C、Hcy、M-ALB、 Scr均高于对照组，Ccr低于正常组，差异有统计学意义（P＜0.05）；GFR低于正常组（P0.05）。在CKD2期血清Cys-C开始升高，并且随着GFR下降逐渐升高；CKD2期Ccr开始下降，CKD3期Hcy、Scr、M-ALB开始升高。④结论：与Scr、Ccr、Hcy、M-ALB相比，胱抑素C可以更为准确、可靠的反映GFR。关键词　肾小球率过滤 慢性肾脏病 胱抑素-Cthe relationship between cystatin c and chronic renal disease in early stage WANG yong-hong JIANG ai-li SU hai-hua ZHANG ting ZHANG jia-longAbstract Objective:To investigate the relationship between cystatin C and chronic renal disease of early stage. Methods:GFR was estimated using the renal dynamic imaging method with 99mTc-diethylene triamine pentaacetic acid(99mTc-DTPA). 67 Patients with chronic renal disease of early stage (GFR30ml/min) were selected as CKD group.CKD group were divided into CKD1 group CKD2 group CKD3 group,according the GFR. Serum cystatin C(Cys-c) homocystein(Hcy) serum creatinine(Scr) endogenous creatinine clearance rate(Ccr)Urine microalbumin(M-ALB)levels were determined.20 health check-up individuals were selected as control group. Detected the Scr Ccr Hcy Cys-C M-ALB of CKD group and control group and analyzed the results. Result:Cys-C、Hcy、Scr、M-ALB had a negative correlation with GFR(P0.05). Cys-C rise at CKD2 stage,beside the lower of GRF, the higher of Cys-C; Ccr rise at the CKD2 stage；M-ALB、Scr、Hcy rise at the CKD3 stage.Conclusion:Serum Cystatin C is an sensitive parameter of GFR,more sensitive than Scr Ccr Hcy M-ALB.Key Words：Glomerular Filtration Rate Chronic Kdney Disease Serum Cystatin-C目前慢性肾脏疾病的实验室诊断多以尿素、肌酐作为主要检测指标，然而这些项目受到年龄、性别、营养状态、感染等多方面的影响，难以对早期肾损伤作出准确诊断，无法满足肾脏病学科的发展需要。本研究通过对此类患者血清胱抑素C（Cys-C）、同型半胱氨酸（Hcy）、血肌酐（Scr）、尿素氮（BUN