| Objective:Diabetic nephropathy cause nephropathy in our coutry,so the diagnosis and therapy in early stage play an important role.The study was performed on 190 Diabetic patients. Serum levels of Cysctain C,β2-microglobulin,creatinine,urea nitrogen and urinary albumin excretion were mensurated. Glomerular filtration rate(GFR) were estimated by the clearance of 99mTc-DTPA in part patients.calculate GFR by formula with Cystatin C and creatinine.We aimed to estimate the clinical significance of cystatin C and GFR calculated by cystatin C in renal impairment of Diabetic.Methods:1.Object collect:First the objects signed informed consent.The object were Diabetic patients hospitalized in shanxi medical university first hospital.they accord with《The standand of diagnosis and class in Diabtic》, at the same time exclude stress,thyroid desease,tumor,beriberoid disease,hepatopathy,other nephrophy,glucocorticoid and immune depressant in use,deficiency of skeletal limbs.2. Sample measure:①record gender,age,height,weight,course of disease and such parameter,calculate body mass index(BMI) BMI=weight/height2(kg/m2)②collect 24 hours urine and get the total amount when the object lead a regular life and diet.mix the urine and get 10 ml to measure urinary albumin excretion(UAE).③draw venous blood 4 ml after absolute diet for 10 hours,measure the level of cys c,creatinine,urea nitrogen andβ2-microglobulin④get 40 samples in random,intravrnous injection 99mTc-DTPA lmci/lml 20 minutes afer drank water 8-10ml per kilogram weight,then draw 5ml venous blood of opposite arm afer 2 hours and 4hours.calculate 99mTc-GFR aferγcamera detecting head get the data.3.Calculate Cys-GFR,simplifed MDRD-GFR(in this article,we use MDRD-GFR instead of simplified MDRD-GFR) MDRD-GFR=186×Cr-1.154×age-2.03×0.742 (female) (Cr mg/dl) Cys-GFR=86.7/Cys C-4.2 (Cys C mg/L)4.Divide the objects into 3 groups according to Mogensen.including normal urinary albumin group(UAE<30mg/24h);then microamont urinary albumin group (UAE 30-300mg/24h);multiplicity urinary albumin(UAE>300mg/24h).Diabetic nephropathy stage method,compare the level of blood marker in different groups,the correlationships between MDRD-GFR,Cys-GFR and 99mTc-GFR,the accuratism of Cys C,Cr,β2-MG. in measuring renal glomerulus filtration function.Result:1. Serum cystatin C levels were significantly higher in microamont urinary albumin group than which in normal urinary albumin group (P<0.05),butβ2-microglobulin,creatinine and urea had not the same conclude.The levels of all above markers were significantly higher in multiplicity urinary albumin group than which in microamont urinary albulmin (P<0.01)2. Cys-GFR,MDRD-GFR had significant correlation with 99mTc-GFR,the correlation coefficient were 0.837,0.7 (P<0.01) and Cys-GFR had the better relation than MDRD-GFR.3. The areas under the ROC curve of Cys C,Cr,β2-MG were 0.897,0.723,0.877. Cys C had the most areas,thenβ2-MG,the least one were creatinine.Conclusion:1.Serum cys C increase significantly in microamont urinary albumin group,so it can indicate the impairment of diabetic nephropathy in early stage more sensitively thanP2-microglobulin,creatinine,urea nitrogen.serum cystatin C will increase with the aggravation of renal function.2.Cys-GFR has better correlationships with 99mTc-GFR than MDRD-GFR,glomerllar filtration rate calculated by cystatin C can represent renal function more precisely.3.Considering both sensitiveness and specificity,cystatin C andβ2-MG is both better than creatinine in indicating the renal glomerulus filtration function. |
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