| Objective:To study the applicability value of serum cystatin C,serum creatinine and urine micro-albumin in the evaluation of renal dis-function in patients with diabetic kidney disease (DKD). And compare the strengths and weaknesses of serum cystatin C,serum creatinine and urine micro-albumin in different protein levels and different renal function.Methods:A total of 110 Patients of type 2 diabetes collected from March in 2013 to October in 2014 among Lanzhou university second hospital,patients with diabetic kidney disease had been researched (Men 55 cases,women 55 cases). Grouping according to the 24h-urinary albumin excretion rate level,70 cases of micro-albuminuria (30-300mg/24h) group (Early diabetic kidney disease ,EDKD group) and 40 cases of macro-proteinuria(≥300mg/24h) group (clinical diabetic kidney disease group,CDKD) group. Serum creatinine and cystatin C were tested for every patient, and creatinine clearance rate (CCr) was measured by Cockcroft-Gault equation, and CCr was more than 90mFmin 94 cases, CCr was between 60 to 90mFmin 36 cases, CCr was less than 60ml/min, 10cases and evaluate the estimated glomerular filtration rate(eGFR) accord to equations MDRD, we take eGFR as evaluation criterion,with as the control group,The correlation between SCr,Cys-C,e GFR and CCr was eval Simple Diabetic Mellitus rated in the different Proteinuria and renal function stages.Furthermore,receiver operator characteristic curve(ROC curve)of SCr,Cys-C and mALB was made,and calculated the area under the curve(AUC) respectively, and compare the sensitivity and specificity of three methods of evaluation.Results:(1) Compared with Simple diabetic mellitus group, patients’ age, gender and body mass index (BMI), diastolic blood pressure, glycosylated hemoglobin and blood fat have not significant difference in the early diabetic nephropathy group and clinical diabetic nephropathy group, while the CysC, Scr, mALB, eGFR has significant statistically difference between the three groups, but on the whole, Scr is more earlier to detect diabetic kidney disease than Scr, mALB.. SCr has no statistically significant difference in Early diabetic kidney disease (micro albuminuria), and in the clinical stage of diabetic nephropathy (Macro-albuminuria), SCr shows significant statistical significance, It means that CysC is more sensitive than SCr in reflecting the changes of renal function. (2) For abnormal renal function,In Simple diabetic mellitus group, the detection rate of CysC is 23.3%,the detection rate of eGFR, SCr and mALB is 0, in the early diabetic nephropathy group, the detection rate of CysC is 37.1%,the detection rate of eGFR is 40%,the detection rate of SCr is 15.7%,the detection rate of mALB is 35.7%;in clinical diabetic nephropathy,the detection rate of CysC is 65%%,the detection rate of eGFR is 72.5%,the detection rate of SCr is 37.5%,the detection rate of mALB is 60%.(3) On the whole, the abnormal renal function detection rate of CysC, Scr, mALB, eGFR in clinical diabetic nephropathy group is higher than the Simple diabetic mellitus group and the early diabetic nephropathy group, it shows that SCr, Cys-C and mALB can reflect the early renal damage earlier in the protein level,; (4) in different protein levels,SCr, Cys C-C and mALB have significant correlation with eGFR, and the Pearson correlation of SCr,Cys-C mALB with eGFR were-0.812(P<0.01),-0.746 (P<0.01),-0.356(P<0.01) respectively, in the early diabetic nephropathy group,the Pearson correlation of SCr,Cys-C mALB with eGFR were -0.713(p<0.01),-0.422(P<0.01),-0.395 (P<0.01) respectively;In clinical diabetic nephropathy group, the Pearson correlation of SCr,Cys-C mALB with eGFR were -0.891 (P<0.01),-0.851 (P<0.01),-0.450(P<0.01) respectively;when CCr was more than 90m Fmin,the Pearson correlation of SCr,Cys-C mALB with eGFR were-0.422(P<0.01),-0.378(P<0.01);-0.143(P<0.01) respectively. When CCr was between 60 to 90mFmin,the Pearson correlation of SCr,Cys-C, mALB with eGFR were -0.435(p<0.01),-0.391(P<0.01),-0.047(P<0.01) respectively;when CCr was less than 60ml/min, the Pearson correlation of SCr, Cys-C, mALB with eGFR were-0.644(P<0.01),-0.482(p<0.01),-0.264(P<0.01) respectively, in different protein levels and different renal function,the pearson correlation of Cys-C with eGFR is best, Compared with Cys-C and SCr,while mALB is lower.In the ROC curves,the area under the curve of the ROC were 0.975,0.924,0.675. The AUCROC of CysC-C is Largest, namely CysC-C has the highest efficiency in the evaluation of renal dis-function in patients with diabetic kidney disease.Conclusions:Compared with serum creatinine, urine micro-albumin, Cystatin C is a more accurate and more sensitive indicators on reflecting the glomerular filtration function.It has important clinical value in detecting early glomerular filtration function damage to patients with diabetic kidney disease. |
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