| Background and objectiveGestational diabetes mellitus (gestational diabetes mellitus, GDM) is the first occurrence of or discovery of different levels of glucose metabolism in abnormal pregnancy. It’s a more common serious complication of pregnancy that occurred in late pregnancy. The effect of GDM on mothers and infants mainly depends on the degree of diabetes and blood glucose control level. Serious illness and poor blood glucose control may influence deeply in maternal and fetal. For pregnant women influences include early spontaneous abortion, pregnancy-induced hypertension syndrome, infection, polyhydramnios, premature delivery, dystocia, and ketoacidosis etc. A fetus, malformation, growth retardation, macrosomia and effects on the fetus. The effect of newborn with hyperinsulinemia, neonatal hypoglycemia, respiratory distress syndrome of the newborn, neonatal polycythemiaThe main harm of GDM is common for vascular disease and diabetic kidney damage. Diabetic nephropathy (diabeticnephroparthy, DN) is composed of diabetes mellitus (Diabetes mellitus, DM) induced renal damage. Diabetic nephropathy is the most common complication of diabetes. Diabetes is one of systemic microvascular disease. Its clinical features are proteinuria, progressive renal dysfunction, hypertension, edema, severe renal failure appeared in the late stage, is one of the major causes of death in patients with diabetes mellitus.If the active treatment given in early diabetic nephropathy, significant improvement of clinical symptoms and prognosis significance in patients with diabetes mellitus, the early diagnosis of diabetic nephropathy is the most importantCystatin C (cystatin C, Cys-C) also known as cystatin C, cysteine protease inhibitors are members of a superfamily of. The gene encoding Cys-C is located on chromosome20p11, about4.3kb in length, including3exons and2introns. Cys-C is a kind of symbol can reflect glomerular filtration function, early detection of diabetic patients with impaired kidney function.Early diagnosis of renal damage of cystatin C, mainly in the following several diseases:①in diabetic nephropathy:diabetic nephropathy is a major complication of diabetes mellitus, developing about1/3diabetic patients needs dialysis for renal failure. The early without any clinical indications, progress is slow. And diabetic nephropathy once entering clinical proteinuria is a serious condition, the development is rapid. So it is particularly important to early nephropathy of diabetes make evaluation appears. Recent studies found that Cys-C levels are more sensitive than other indices that serum Cys-C is a sensitive index of early diabetic renal damage, which has a certain value for the early diagnosis of diabetic nephropathy, renal function damage degree and location of judgment.②Application in renal tubular diseases:cystatin C from the glomerular filtration is free, the tubular reabsorption and all in the renal tubular catabolism, only a few will be eliminated in urine. Therefore, in theory it can be speculated that, if the renal tubular lesions, the decomposition of Cys-c diminished capacity. It is bound to observe that the Cys-c excreted in urine increased. Recently conti M confirmed this conjecture, proved that the concentration of Cys-c in the urine in the diagnosis of renal tubular function is not important in all aspects.③Application in acute renal failure, acute renal failure (acute renal failure, ARF) of the traditional fault diagnosis method is judged according to serum creatinine levels, but serum creatinine level is affected by many factors:reaction of GFR is not sensitive and accurate, particularly moderate damage in renal function. Recently, through the study of serum creatinine, serum concentrations of Cys-C and GFR, find a better correlation between Cys-C and GFR. There was significant difference of two area under the curve of AUC, and found that ARF patients, only a small part of elevated serum creatinine, and most of the concentration of serum Cys-C increased. In order to confirm the diagnostic value of Cys-C on ARF than creatinine more.④Application in renal transplantation:also found the lack of correlation graft in early Cys-C and serum creatinine and Cys-C, and that by18months after transplantation, Cys-C and Ccr showed a good correlation. Visible, Cys-C and renal function are closely related.At present, the gestational diabetes renal injury of renal damage is mainly through the determination of serum Scr, BUN, UA, β2-mg, urine protein. Serum creatinine is vulnerable to exogenous CR intake of individual muscle mass difference in age gender race influence, only in the glomerular filtration rate fell to below50%of normal. Serum creatinine is sensitivity. But the serum Scr in GFR decreases to1/3will significantly increase. These indicators exist shortcomings.Cys-C in diabetic nephropathy, renal tubular disease, acute renal failure and renal transplantation in the early diagnosis of renal function is of important value. It can make up for the early diagnosis of diabetic renal insufficiency of pregnancy, so this study aims is to study the Cys-C in the diagnosis of gestational diabetes mellitus patients with early renal impairment in value. In order to the prevention of adverse pregnancy outcomes of gestational diabetes take corresponding measures in time.Research methods1research subjects:In January2013to2012in singleton pregnancies south hospital cards, at the age of23-38years old, excluding those with hypertension, high blood fat, liver and kidney disease, thyroid and had a history of diabetes or multiple pregnancy. All subjects in14-27weeks pregnancy (pregnant),28-36weeks (late pregnancy) were glucose Screening test (glucose challenge test GCT); glucose Screening is abnormal, oral glucose tolerance test (oral glucose tolerance test OGTT).2cases:Screening of pregnant women in late pregnancy,24cases of GDM were selected as case group. Randomly selected normal pregnancy, late pregnancy women in all24patients as control group.3monitoring indicators:all pregnant women at14-27weeks of gestation (pregnant),28-36weeks (late pregnancy), was collected3ml venous blood, overnight fasting10hours, morning at around8vein blood samples, tested serum cystatin C (Cys-C), serum creatinine (serum creainine, Scr), uric acid (uric acid, UA) level. Transmission immunoassay technology enhanced detection of cystatin C particles. Having a comparison on the pregnant group, normal pregnancy in normal pregnancy pregnant, pregnant group in diabetes mellitus and pregnancy diabetes during late pregnancy the concentration of uric acid in serum, normal pregnancy group, late pregnant group, normal pregnancy group diabetes in pregnancy and gestational diabetes mellitus pregnant serum cystatin C concentration of pregnancy were compared. Normal pregnancy group, late pregnant group, normal pregnancy group diabetes in pregnancy and gestational diabetes during late pregnancy creatinine concentration in serum were compared.4statistical analysis:using SPSS11statistical analysis software. Results are meant by±standard deviation (where x±S). The differences between two groups were compared by two independent sample t test. multiple groups among groups were compared by analysis of variance. Comparison of four groups of table X2test ratio. Analysis using Person correlation analysis correlation among parameters P<0.05was significant difference. research results1cases and control group of serum uric acid and laboratory test results:compared to normal pregnancy group, late pregnant group, normal pregnancy group diabetes in pregnancy and the concentration of uric acid in serum of diabetes during late pregnancy pregnancy, One-way ANOVA analysis. Results:F=17.425, P<0.001, the difference was statistically significant between groups shows that different groups, different concentration of serum uric acid, the need for further multiple comparisons. Pregnancy gestational diabetes in pregnancy group VS normal pregnancy, no significant difference (P>0.05); late pregnancy group and normal pregnancy group VS normal pregnancy, the difference was statistically significant (P<0.05); diabetic pregnant pregnancy pregnant group VS normal pregnancy, the difference was statistically significant (P<0.05); pregnancy diabetes gestational diabetes mellitus pregnant pregnancy pregnant group VS, the difference was statistically significant (P<0.05). That is not only in patients with gestational diabetes mellitus, normal pregnancy women in late pregnancy the uric acid levels also increased with the gestational weeks of pregnancy is higher than the level of uric acid.2. Case group and control group of serum C laboratory testing results:comparison of in normal pregnancy group, the normal late pregnancy conceived, gestational diabetes during pregnancy and gestational diabetes late pregnant group and urinary chalone C concentration in serum, for One-way ANOVA analysis. Results indicate:F=29.419, P<0.001, suggesting that difference have statistical significance between different groups can be thought of urinary chalone C concentration in serum, multiple comparison should be carried out further. In normal pregnancy group VS normal late pregnancy conceived group, there was no statistically significant difference (P>0.05); In normal pregnancy pregnant group VS gestational diabetes in pregnancy group, there was no statistically significant difference (P>0.05); Normal late pregnant group VS pregnancy gestational diabetes late pregnancy group, the difference was statistically significant (P<0.05); Gestational diabetes in pregnancy group VS gestational diabetes late pregnancy group, the difference was statistically significant (P<0.05); Normal urinary chalone C changes in serum level of pregnant women in pregnancy and late pregnancy had no significant difference. Late pregnancy and gestational diabetes patients level is significantly higher than in the pregnant group, and with the increase of gestational age, gestational diabetes group of Cys-C concentration increases3. Case group and the control group, serum creatinine laboratory testing results:in normal pregnancy group, the normal late pregnancy conceived, gestational diabetes during pregnancy and gestational diabetes late pregnant group in serum creatinine concentration, for One-way ANOVA analysis. Results indicate:F=11.555, P<0.001, suggesting that difference between groups was statistically significant. Serum creatinine concentration is different between different groups. It can be thought of multiple comparison should be carried out further. Normal late pregnant group VS pregnancy gestational diabetes late pregnancy group, there was no statistically significant difference (P>0.05); Gestational diabetes in pregnancy group VS gestational diabetes late pregnancy group, there was no statistically significant difference (P>0.05); Group VS normal late pregnancy conceived in normal pregnancy group, the difference was statistically significant (P<0.05); In normal pregnancy pregnant group VS gestational diabetes in pregnancy group, the difference was statistically significant (P<0.05); It shows that not only in gestational diabetes late pregnant group but in the pregnant group and late pregnant group than in normal pregnancy pregnant creatinine has no obvious rise in the group of normal pregnancy women of late pregnancy creatinine level also increased with the increase of gestational age is higher than the creatinine level during pregnancy. And serum creatinine levels in the gestational diabetes during pregnancy increased significantly.4. Cys-C, UA and Scr comparative the levels of serum UA and Scr in late pregnancy levels in case group and the control group were significantly higher in pregnancy (P<0.05). Compared with normal pregnant women and patients with gestational diabetes, serum UA level during the pregnancy had no significant difference (P>0.05). Serum levels of Scr during late pregnancy had no significant difference (P>0.05). However, during the pregnancy, gestational diabetes patients’serum levels of Scr is significantly higher than normal pregnant women (P<0.05) and late pregnancy, gestational diabetes patients serum UA level is significantly higher than normal pregnant women (P<0.05). For the change of the serum Cys C-, and UA and Scr, normal pregnant women in pregnancy and late pregnancy had no significant difference. Late pregnancy and gestational diabetes patients had a significantly higher level in the pregnant group (P<0.05). Cys-C compared to the UA, Scr can reflect the change of early renal damage of diabetic nephropathy.Research conclusion1. The changing law in normal pregnancy pregnant women serum uric acid, serum creatinine and urinary chalone serum level of C. The results showed that serum uric acid and serum creatinine level, normal late pregnant group is higher than in normal pregnancy conceived pregnancy significantly increases. But urinary chalone C levels of serum in normal late pregnant group and in normal pregnancy conceived pregnancy has no obvious changes. This may be due to renal system and blood volume caused by a series of change, including increased renal plasma flow, increased glomerular filtration rate, and low blood volume status, leading to uric acid increased absorption and secretion of serum creatinine increase. And serum Cys-C concentration has no obvious change.2. The changing law in gestational diabetes, pregnant women serum uric acid, serum creatinine and urinary chalone serum level of C. Urinary chalone C levels of serum uric acid and serum, gestational diabetes late pregnancy is significantly higher than gestational diabetes in pregnancy group, while serum creatinine levels, gestational diabetes late pregnancy and gestational diabetes in pregnancy group has no obvious change. It means that the urinary chalone C level of serum uric acid and serum in late gestational diabetes during pregnancy is significant higher than in gestational diabetes during pregnancy. Tips and gestational diabetes increased with the increase of gestational age progressive renal function is impaired. And elevated serum creatinine level has no obvious change.3. levels and significance in gestational diabetes in pregnant women with normal urinary chalone pregnant women serum uric acid level and the relations between C and serum creatinine.Urinary chalone C levels of serum uric acid and serum, gestational diabetes in pregnancy group and normal pregnancy pregnant group have no obvious change, while serum creatinine levels, gestational diabetes in pregnancy group has a significant rise in normal pregnancy pregnant group. Prompt gestational diabetes renal damage are mostly occurs in late pregnancy. And a significant rise in serum creatinine levels in the gestational diabetes during pregnancy, but no obvious rise in late gestational diabetes. Instructions on reflecting the glomeruli and serum creatinine are less sensitive.Urinary chalone C levels of serum uric acid and serum, gestational diabetes in late pregnancy pregnant is significantly higher than normal pregnancy group, while serum creatinine levels, gestational diabetes in late pregnancy pregnant and normal pregnancy group has no obvious change. It suggests that late gestational diabetes during pregnancy, urinary chalone C levels of serum uric acid and serum increased significantly, and there was no significant alteration of the serum creatinine level.Urinary chalone C levels of serum uric acid and serum, gestational diabetes in late pregnancy is significantly higher than gestational diabetes in pregnancy group, while serum creatinine levels, gestational diabetes late pregnancy and gestational diabetes in pregnancy group has no obvious change. It means that urinary chalone C levels of serum uric acid and serum in late gestational diabetes during pregnancy has a significant rise but gestational diabetes during pregnancy none. It prompted that gestational diabetes increased with the increase of gestational age progressive renal function is impaired. And elevated serum creatinine level has no obvious rising. 4. Cys-c UA Scr comparison and significanceWhen the detected serum creatinine abnormal, chronic kidney disease has been in the middle and late period. It is less sensitive, and reliable in reflecting glomerular function, serum creatinine. Serum uric acid and serum creatinine levels.Normal third trimester of pregnancy compared with normal pregnancy pregnancy, the normal third trimester of pregnancy has significantly increased. But serum cystatin C level has no significant change. Serum uric acid and serum cystatin C levels in gestational diabetes late in pregnancy was significantly higher than gestational diabetes in pregnancy. While no significant increase in serum creatinine levels.Therefore, serum Cys is more sensitive than Scr, UA, the more reliable diagnosis of gestational diabetes in patients with early renal dysfunction.In summary, the diagnosis has important reference value and clinical significance of serum cystatin C detection of gestational diabetes in patients with early renal damage. |
