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目的探讨半胱氨酸蛋白酶抑制剂C(cysteine proteinase inhibitors C,Cys C)及其肾小球滤过率(GFR)评估方程在糖尿病肾病(DN)及其分期中的应用。方法选取2014年1月至9月住院的糖尿病(DM)患者202例。根据Mogensen标准对糖尿病患者进行分组:单纯DM组(n=113),早期DN组(n=70),临床DN组(n=19)。并以CKD-EPIcys方程评估的GFR(e GFR)值为标准,参考美国K/DOQI标准,将糖尿病患者分为CKD I期(n=51),II期(n=81),III~V期组(n=70)。血清Cys C采用透射比浊法检测,尿微量白蛋白(m Alb)采用免疫比浊法检测。比较各临床分期的Cys C水平。通过CKD-EPIcys方程和Fengcys、Macys、ZHcys方程评估入选患者预测GFR(e GFR),并进行比较。结果血清Cys C水平早期DN组[(1.17±0.35)mg/L]及临床DN组[(1.74±0.96)mg/L]均显著高于单纯DM组[(1.01±0.23)mg/L](P均<0.01)。由CKD-EPIcys方程及Fengcys、Macys、ZHcys方程估算的e GFR值,单纯DM组与早期DN组、临床DN组相比较,差异均有统计学差异(P均<0.01);在CKD I~V期,Macys方程、ZHcys方程估算的e GFR值均高于CKD-EPIcys方程(P均<0.01);在CKD I期,Fengcys方程e GFR值与CKDEPIcys方程差异无统计学意义(P>0.05),但在CKD II~V期则显著高于CKD-EPIcys方程(P均<0.01)。结论血清Cys C水平及其评估方程可较好的反映出DN的早期肾损害,在评估DN患者GFR时,与CKD-EPIcys方程相比,Fengcys、Macys、ZHcys方程存在高估现象,在DN患者中应用有待进一步的研究证实。
Objective To investigate the evaluation of cysteine proteinase inhibitor C (Cys C) and its glomerular filtration rate (GFR) in diabetic nephropathy (DN) and its staging. Methods Totally 202 diabetic patients (DM) hospitalized from January to September in 2014 were selected. Diabetic patients were grouped according to the Mogensen criteria: DM group (n = 113), early DN group (n = 70) and clinical DN group (n = 19). The patients with diabetes mellitus were divided into CKD stage I (n = 51), stage II (n = 81), stage III-V with reference to the American K / DOQI standard, using the GFR Group (n = 70). Serum Cys C was measured by transmission turbidimetry and urine microalbumin (m Alb) was detected by immunoturbidimetry. Cys C levels in each clinical stage were compared. Predict GFR (e GFR) in selected patients by CKD-EPIcys equation and Fengcys, Macys, ZHcys equation were compared and compared. Results Serum Cys C levels were significantly higher in DN group (1.17 ± 0.35 mg / L) and DN group (1.74 ± 0.96 mg / L) than those in DM group (1.01 ± 0.23 mg / L) P <0.01). The eGFR values estimated by the CKD-EPIcys equation and the Fengcys, Macys, ZHcys equation were significantly different (P <0.01) in the DM group compared with the early DN group and the DN group (P <0.01) (P <0.05). The e GFR values of the Fengcys equation were not significantly different from those of the CKDEPIcys equation in CKD stage I, Macys equation and ZHcys equation (P <0.05) However, the CKD-EPIcys equation in CKD stage II-V was significantly higher than that in CKD-EPIcys equation (all P <0.01). Conclusion The serum Cys C level and its assessment equation can better reflect the early renal damage of DN. Compared with CKD-EPIcys equation, Fengcys, Macys and ZHcys equation are overvalued in evaluating GFR of DN patients. The application needs further study confirmed.