HbA1c、Cys—C、Hcy水平与糖尿病患者肾脏功能损害的相关性研究(1)
【摘要】 目的：探讨全血糖化血红蛋白(HbA1c)及血清胱抑素C(Cys-C)、同型半胱氨酸(Hcy)水平与糖尿病患者肾脏功能损害的相关性。方法：选取2014年7月-2015年8月本院收治的2型糖尿病患者181例作为观察组，根据尿蛋白排泄率(UAER)分为三组，分别为正常蛋白尿组(UAER<30 mg/24 h，n=53)、微量蛋白尿组(UAER 30～300 mg/24 h，n=70)、临床蛋白尿组(UAER>300 mg/24 h，n=58)，另选取同期在本院体检的健康志愿者60例作为对照组。所有患者及健康体检者均测量全血HbA1c、Cys-C、Hcy水平，估算肾小球滤过率(eGFR)，并进行组间比较，采用Pearson相关分析探讨全血HbA1c及血清Cys-C、Hcy水平与eGFR的关系。结果：HbA1c、Cys-C、Hcy水平在对照组、正常蛋白尿组、微量蛋白尿组、临床蛋白尿组中依次升高，而eGFR依次降低，组间差异均有统计学意义(P<0.05)；Pearson相关分析显示，HbA1c、Cys-C、Hcy水平与eGFR呈明显负相关(r=-0.152、-0.116、-0.237，P<0.05)；ROC曲线分析显示，以HbA1c、Cys-C、Hcy联合检测诊断2型糖尿病患者早期肾损伤的曲线下面积(AUC)明显大于HbA1c、Cys-C、Hcy单项检测。结论：糖尿病患者全血HbA1c及血清Cys-C、Hcy水平升高，对糖尿病患者早期肾脏功能损害诊治具有一定的参考价值。
【关键词】 糖尿病肾病； 糖化血红蛋白； 胱抑素C； 同型半胱氨酸； 诊断
【Abstract】 Objective：To discuss the correlation of glucose hemoglobin (HbA1c) and serum cystatin C (Cys-C)，homocysteine ?(Hcy)levels and renal damage on patients with type 2 diabetes diabetic.Method：A total of 181 patients with type 2 diabetes in our hospital between July 2014 to August 2015 were selected and divided into three groups according to the rate of urinary albumin excretion (UAER)，normal albuminuria group (UAER<30 mg/24 h，n=53)，microalbuminuria (UAER 30-300 mg/24 h，n=70)，clinical albuminuria group (UAER>300 mg/24 h，n=58) respectively， and 60 cases of healthy volunteers at the same period were selected as control group.The levels of whole blood HbA1c and Cys-C，Hcy were detected，and the rate of glomerular filtration (eGFR) were estimated.The relationship of HbA1c，Cys-C，Hcy levels and eGFR were analyzed by Pearson correlation analysis.Result：There were statistically significant difference between the four groups on the levels of HbA1c，Cys-C，Hcy，eGFR (P<0.05).Pearson correlation analysis showed that，HbA1c，Cys-C，Hcy levels was negatively correlated with eGFR (r=-0.152，-0.116，-0.237，P<0.05).ROC curve analysis showed that，the area under the curve (AUC) of HbA1c，Cys-C，Hcy were significantly greater than HbA1c，Cys-C，Hcy single detection on the diagnosis of early renal damage in type 2 diabetic patients.Conclusion：The levels of whole blood HbA1c and serum Cys-C，Hcy of patients with type 2 diabetes increase，with some reference value for early diagnosis and treatment of renal damage in diabetic patients.
【Key words】 Diabetic nephropathy； Glycated hemoglobin； Cystatin C； Homocysteine； Diagnosis
First-author’s address：The Third People’s Hospital of Huizhou City，Huizhou 516002，China
doi：10.3969/j.issn.1674-4985.2016.11.012
糖尿病是一种以高血糖为主要特征的慢性非传染病，可引起机体多系统的损害，严重危害人类身心健康。其中糖尿病肾病是糖尿病较为常见的微血管并发症，是导致肾功能衰竭的首要原因，然而糖尿病患者早期肾功能损害可逆转，故寻找敏感、有效、可定量的临床指标诊断早期肾功能损害对糖尿病肾病患者的早期诊治具有十分重要的临床意义。目前，临床主要采用尿微量白蛋白、肌酐、尿素氮等检测糖尿病患者肾功能，但上述指标敏感度均较差，具有一定的局限性[1]。研究发现，糖化血红蛋白(HbA1c)、胱抑素C(Cys-C)、同型半胱氨酸(Hcy)可能是糖尿病早期肾功能损害的临床指标[2]。因此，本研究通过研究2型糖尿病患者全血HbA1c及血清Cys-C，Hcy水平。探讨其在2型糖尿病患者早期肾功能损害诊断中的临床应用价值，为糖尿病肾病的早期诊断及临床治疗提供参考性的理论依据。现报道如下。, 百拇医药(林彩凤)
【关键词】 糖尿病肾病； 糖化血红蛋白； 胱抑素C； 同型半胱氨酸； 诊断
【Abstract】 Objective：To discuss the correlation of glucose hemoglobin (HbA1c) and serum cystatin C (Cys-C)，homocysteine ?(Hcy)levels and renal damage on patients with type 2 diabetes diabetic.Method：A total of 181 patients with type 2 diabetes in our hospital between July 2014 to August 2015 were selected and divided into three groups according to the rate of urinary albumin excretion (UAER)，normal albuminuria group (UAER<30 mg/24 h，n=53)，microalbuminuria (UAER 30-300 mg/24 h，n=70)，clinical albuminuria group (UAER>300 mg/24 h，n=58) respectively， and 60 cases of healthy volunteers at the same period were selected as control group.The levels of whole blood HbA1c and Cys-C，Hcy were detected，and the rate of glomerular filtration (eGFR) were estimated.The relationship of HbA1c，Cys-C，Hcy levels and eGFR were analyzed by Pearson correlation analysis.Result：There were statistically significant difference between the four groups on the levels of HbA1c，Cys-C，Hcy，eGFR (P<0.05).Pearson correlation analysis showed that，HbA1c，Cys-C，Hcy levels was negatively correlated with eGFR (r=-0.152，-0.116，-0.237，P<0.05).ROC curve analysis showed that，the area under the curve (AUC) of HbA1c，Cys-C，Hcy were significantly greater than HbA1c，Cys-C，Hcy single detection on the diagnosis of early renal damage in type 2 diabetic patients.Conclusion：The levels of whole blood HbA1c and serum Cys-C，Hcy of patients with type 2 diabetes increase，with some reference value for early diagnosis and treatment of renal damage in diabetic patients.
【Key words】 Diabetic nephropathy； Glycated hemoglobin； Cystatin C； Homocysteine； Diagnosis
First-author’s address：The Third People’s Hospital of Huizhou City，Huizhou 516002，China
doi：10.3969/j.issn.1674-4985.2016.11.012
糖尿病是一种以高血糖为主要特征的慢性非传染病，可引起机体多系统的损害，严重危害人类身心健康。其中糖尿病肾病是糖尿病较为常见的微血管并发症，是导致肾功能衰竭的首要原因，然而糖尿病患者早期肾功能损害可逆转，故寻找敏感、有效、可定量的临床指标诊断早期肾功能损害对糖尿病肾病患者的早期诊治具有十分重要的临床意义。目前，临床主要采用尿微量白蛋白、肌酐、尿素氮等检测糖尿病患者肾功能，但上述指标敏感度均较差，具有一定的局限性[1]。研究发现，糖化血红蛋白(HbA1c)、胱抑素C(Cys-C)、同型半胱氨酸(Hcy)可能是糖尿病早期肾功能损害的临床指标[2]。因此，本研究通过研究2型糖尿病患者全血HbA1c及血清Cys-C，Hcy水平。探讨其在2型糖尿病患者早期肾功能损害诊断中的临床应用价值，为糖尿病肾病的早期诊断及临床治疗提供参考性的理论依据。现报道如下。, 百拇医药(林彩凤)