| Objective:To investigate the diagnostic value of homocysteine(Hcy)combined with cystatin C(Cys C)in hypertensive elderly patients with early renal injury.Methods:According to the inclusion and exclusion criteria,a total of 104 elderly patients with essential hypertension were enrolled in the First Affiliated Hospital of Bengbu Medical College.According to the MDRD formula for estimating glomerular filtration rate and chronic kidney disease staging criteria recommended by the KDIGO Guide(2012 Edition),patients were divided into hypertensive renal impairment group(n = 53)and simple hypertensive group(n = 51).Another 48 elderly healthy subjects were selected as the control group.Homocysteine,cystatin C and creatinine were measured in all study subjects,and the levels of each index in each group were compared.The Logistic regression model was established by combined detection indicators and the diagnostic value of each test index in hypertensive renal injury was evaluated by receiver operating characteristic curve(ROC curve).the diagnostic threshold was determined according to the maximum Youden index.Results:1.There was no significant difference between the three groups in terms of age and gender(P>0.05).2.The average levels of Hcy in the three groups were(17.346 ± 4.215)?mol/L,(12.711 ± 1.692)?mol/L and(8.583 ± 1.615)?mol/L respectively.The average levels of Cys C were(1.751 ± 0.656)mg/L,(1.098 ± 0.277)mg/L,(0.766 ± 0.165)mg/L.The average levels of Cr were(75.011±14.496)?mol/L,(64.985±9.458)?mol/L,and(60.965±7.619)?mol/L,respectively.The mean levels of Hcy,Cys C and Cr in hypertensive renal injury group were significantly higher than those in simple hypertensive group,and the differences were statistically significant(P<0.01).The average levels of Hcy and Cys C in hypertension group were higher than those in control group,and the difference was statistically significant(P<0.01).but for Cr,there was no significant difference between the simple hypertension group and the control group(P>0.05).3.The area under the ROC curve(AUC value)for detecting early renal damage with hypertension by each index was: Hcy+Cys C(0.959)> Cys C+Cr(0.922)> Hcy+Cr(0.920)> Cys C(0.910)> Hcy(0.907)>Cr(0.742).Hcy,Cys C inde pendently used in the detection of early renal damage was significantly better than the value of Cr.Hcy+Cys C had the highest AUC value,which had high sensitivity(88.7%)and specificity(88.9%)at the optimal diagnostic threshold.4.When each index at the best diagnostic threshold,the sensitivity of Cr,Hcy,Cys C,Hcy+Cr,Cys C+Cr,Hcy+Cys C in diagnosing early renal injury of hypertension was 47.2%,83.0%,83.0%,67.9%,81.1%,88.7%,respectively.This shows that the combined detection of Hcy and Cys C for early renal injury in hypertension is better than the independent detection of all indexes.Conclusion:1.The levels of Hcy and CysC in patients with hypertensive renal injury were significantly higher than control group,and can be used as a sensitive indicator of early diagnosis of hypertensive renal injury.2.The diagnostic value of combined detection of Hcy and Cys C is better than that of each index alone,and the sensitivity and specificity is high.It is of high clinical value for early diagnosis of renal injury in elderly patients with hypertension. |
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