目的 測定多發性骨髓瘤（MM）患者血清胱抑素C （Cys-C） 的水平，探討Cys-C與國際分期體系（ISS）、血β2-微球蛋白、溶骨性損害等指標的關系。 方法 收集2008年1月－2010年9月32例初治和8例復發的MM患者作為研究對象，同時收集40例健康體檢者的檢查資料作為對照組，測定血清Cys-C、血肌酐（Scr）、血β2-微球蛋白。采用核素全身骨顯像（ECT）觀察患者的溶骨性病變部位數。 結果 患者血清Cys-C水平（1.40 mg/L）明顯高于健康對照組（0.90 mg/L）（P＜0.01）；在MM患者中Cys-C比Scr更敏感，能反映腎小球濾過率；血清Cys-C水平與ISS分期晚，血β2-微球蛋白升高以及溶骨性病變進展密切相關。 結論 MM患者的Cys-C水平高于健康者。Cys-C是骨髓瘤腎損害的早期敏感標志物，與腫瘤負荷及溶骨性損害密切相關，可作為評價腫瘤負荷的潛在指標。Objective To evaluate the serum levels of cystatin-C in patients with multiple myeloma (MM), and to explore its possible correlations with clinical data, including ISS stage, serum β2-microglobulin, and advanced lytic lesions. Methods From January 2008 to September 2010, serum cystatin-C, creatinine (Scr), and β2-microglobulin in 32 patients with MM, 8 patients with relapsed disease, and in 40 healthy controls were detected by automatic biochemistry analyzer detection. According to skeleton ECT, grading of osteolytic lesion was observed. Results The levels of serum cystatin-C of patients with MM were significantly higher than those of the controls. Serum cystatin-C could reflect the glomerular filtration rate , and was more sensitive than Scr in patients with renal lesion. Serum cystatin-C had ber correlations with advanced ISS stages, high levels of serum β2-microglobulin, and extensive bone diseases. Conclusion Serum cystatin-C is a sensitive marker of renal lesion in patients with MM, it could be a potential indicator to assess the tumor burden.
目的 探討血清中胱抑素C（Cys-C）在糖尿病、高血壓為主要原發疾病的慢性腎病患者進行早期篩查和監測的臨床意義。 方法 收集2007年7月－2009年3月由糖尿病、高血壓引起慢性腎病患者的血清，采用微粒子增強免疫透射比濁分析法測定由89例糖尿病、76例高血壓引起慢性腎病患者血清Cys-C濃度，同時測定其血清尿素氮（BUN）、肌酐（Scr）、尿白蛋白排泄率（UAER），根據UAER的量分組統計，分析血清Cys-C與其他傳統腎功能指標的相關性。 結果 由于高血壓、糖尿病等慢性疾病引起早期腎病時，患者血清Cys-C、UAER與正常對照組間差異有統計學意義（P＜0.01），而傳統的腎功指標BUN、Scr與正常對照組差異無統計學意義（P＞0.05）,在中晚期腎病患者中Cys-C濃度與UAER 、BUN、Scr呈顯著正相關（r=0.936，0.692，0.653；P＜0.01)。 結論 與BUN、Scr相比，血清Cys-C是一個更準確、更敏感反映早期腎病的指標，是糖尿病/高血壓患者早期發現腎病并發癥的一項重要監測指標，具有臨床意義。
【摘要】 目的 以99mTc-DTPA腎動態顯像法腎小球濾過率（glomerular filtration rate，GFR）測定為標準，將血清胱抑素C（cystatin C， CysC）檢測與其比較，探討CysC測定在2型糖尿病腎病（type 2 diabetic nephropathy，T2DN）診斷中的意義。 方法 2010年6月—2011年1月76例2型糖尿病（type 2 diabetes mellitus，T2DM）患者按24 h尿微量白蛋白（microalbuminuria，m-Alb）分為兩組:正常蛋白尿組（31例）和微量蛋白尿組（45例），同時測定GFR、CysC、血清肌酐（serum creatinine， Scr）和糖化血紅蛋白（hemoglobin A1c， HbA1c），并設正常自愿者38名作為對照組，進行統計學分析。 結果 對照組、T2DM正常蛋白尿組及T2DM微量蛋白尿組CysC水平分別為（1.1±0.6）、（1.6±0.7）、（1.0±0.3） mg/L，各組差異均有統計學意義（Plt;0.05）；HbA1c水平分別為（5.4±0.6）%、（7.1±2.7）%、（7.9±3.1）%、兩組T2DM患者與對照組比較，差異均有統計學意義（Plt;0.05）；GFR水平分別為（80.9±23.0）、（74.2±26.1）、（79.3±19.7） mL/（min?1.73 m2），各組差異無統計學意義（Pgt;0.05）；Scr水平分別為（87.7±23.8）、（93.7±38.4）、（81.5±11.4） μmol/L，組間差異無統計學意義（Pgt;0.05）。CysC、Scr和GFR之間呈負相關（r=-0.694，-0.692；Plt;0.001）；CysC和Scr之間呈正相關（r=0.903，Plt;0.001）。 結論 CysC可作為早期T2DN的檢測指標，具有較高的敏感性，但對于輕度到中度GFR降低的診斷準確性并不優于Scr。【Abstract】 Objective To demonstrate the clinical value of serum cystatin-C (CysC) in the assessment of renal function in type-2 diabetic nephropathy (T2DN) by comparing it with the glomerular filtration rate (GFR) measured by 99mTc-DTPA method. Methods From June 2010 to January 2011, 76 patients with type 2 diabetes mellitus (T2DM) were classified into two groups according to their 24 h microalbuminuria (m-Alb) level: the normal albuminuric group (n=31) and the microalbuminuric group (n=45). GFR, Serum creatinine (Scr), CysC, and hemoglobin A1c (HbA1c) were measured. Thirty-eight healthy subjects were recruited as the control group, and statistical analysis was carried out. Results The CysC levels in the control group, the normal albuminuric group and the microalbuminuria group were respectively (1.1±0.6), (1.6±0.7) and (1.0±0.3) mg/L, with a significant difference among the three groups (Plt;0.05). HbA1c level in the three groups were respectively (7.1±2.7)%, (7.9±3.1)% and (5.4±0.6)%, with a significant difference between the two diabetic groups and the control group (Plt;0.05). Scr levels in the three groups were respectively (87.7±23.8), (93.7±38.4), (81.5±11.4) μmol/L; GFR levels in the three groups were respectively (80.9±23.0), (74.2±26.1), (79.3±19.7) mL/(min?1.73 m2); among the three groups the differences of both Scr and GFR were not significant. Both CysC and Scr were negatively correlated with GFR (r=-0.694,-0.692;Plt;0.001), and CysC was positively correlated with Scr (r=0.903, Plt;0.001). Conclusion Increased CysC may be an early indicator of incipient diabetic nephropathy, but the diagnostic accuracy of CysC is not superior to that of Scr in distinguishing between mildly and moderately reduced GFR.
【摘要】 目的 探討老年糖尿病患者血清胱抑素C與血脂及高敏C反應蛋白的關系。 方法 2008年5月-2009年10月糖尿病患者共141例，其中糖尿病合并癥組68例，單純糖尿病組73例；另選取對照組51例。對入選者的血清胱抑素C、血脂及高敏C反應蛋白進行分析。 結果 老年男女糖尿病合并癥組血清胱抑素C、高敏C反應蛋白、總膽固醇、甘油三酯及低密度脂蛋白膽固醇最高、高密度脂蛋白膽固醇最低，與對照組比較有統計學意義（Plt;0.05）、與單純糖尿病組比較，無統計學意義（Pgt;0.05）。老年男女單純糖尿病組高敏C反應蛋白、總膽固醇、甘油三酯高于對照組，組間比較，有統計學意義（Plt;0.05）。老年男女單純糖尿病組血清胱抑素C與對照組比較，無統率學意義（Pgt;0.05）。老年女性單純糖尿病組低密度脂蛋白膽固醇與對照組比較，有統計學意義（Plt;0.05）。老年男性糖尿病二組與對照組血清胱抑素C低于老年女性糖尿病二組與對照組，組間比較，無統計學意義（Pgt;0.05）。老年男性糖尿病患者血清胱抑素C與高敏C反應蛋白及血脂不相關。老年女性糖尿病合并癥組血清胱抑素C與空腹血糖正相關；單純糖尿病組血清胱抑素C與高密度脂蛋白膽固醇負相關、與低密度脂蛋白膽固醇正相關、與高敏C反應蛋白不相關。 結論 老年糖尿病患者高脂、高糖及低度炎癥狀態下，血清胱抑素C水平較高。血脂對血清胱抑素C的影響可能存在性別差異。隨著動脈粥樣硬化的加重，血清胱抑素C有升高趨勢。【Abstract】 Objective To investigate the relationship between serum cystatin C concentration and lipid, hs-C reactive protein in the elderly with diabetes. Methods A total of 192 senile people form May 2008 to October 2009 were investigated. There were 141 patients with diabetes, in whom 68 were with cardiovascular and cor, cerebrovascular diseases, 73 were with diabetes only.There were 51 control subjects. The data of serum cystatin C, hs-CRP, TC, TG, HDL-C and LDL-C were analyzed. Results Serum cystatin C of elderly men was lower than that in elderly women, but no signifcant correlation between them was found (Pgt;0.05). Serum cystatin C, hs-CRP, TC, TG and LDL-C was higher, and HDL-C was lower in male and female diabetes subjects with cardiovascular and cor, cerebrovascullar diseases, than that in control subjects (Plt;0.05). Serum hs-CRP, TC and TG were higher in the elderly with diabetes only, than that in control subjects (Plt;0.05). LDL-C was higher in senile women with diabetes only, than that in female control subjects (Plt;0.05). Serum cystatin C with LDL-C in elderly women with diabetes only, with FPG in female diabetes subjects with cardiovascular and cor, cerebrovascular diseases had position correlation (Plt;0.05). No correlation were observed between serum cystatin C and hs-CRP in male and female diabetes subjects, and lipid in male diabetes subjects. Conclusions We speculate that high serum lipid, high glucose and low level of inflammation may result in increasing of serum cystatin C in senily people with diabetes. The influence of serum lipid on serum cystatin C may be different in male and female senile people.Along with atherosclerotic aggravating, the level of serum cystatin C was increasing.
目的探討尿酸干預治療對高尿酸血癥合并糖尿病前期患者腎臟損害的影響。 方法選擇2008年2月－2011年8月在院診治的男性無癥狀高尿酸血癥合并糖尿病前期患者50例，給予低嘌呤飲食聯合降尿酸藥物干預治療；隨訪1年，比較治療前后尿微尿白蛋白（MAU）、血清胱抑素C（CysC）、尿酸和空腹血糖（FPG）。 結果治療前后尿酸分別為（509.40±36.00）、（340.00±39.00）μmol/L，FPG分別為（6.78±0.21）、（5.75±0.65）mmol/L，MAU分別為（45.60±18.30）、（26.30±10.50）mg/L，CysC分別為（1.36±0.15）、（0.89±0.33）mg/L，治療后各指標均較治療前降低，差異有統計學意義（P＜0.05）。 結論血尿酸干預治療可降低高尿酸血癥合并糖尿病前期患者的腎臟損害，并可降低其FPG水平。