Cyc与β2-MG在糖尿病肾病早期诊断中的应用价值.docx

Cyc与β2-MG在糖尿病肾病早期诊断中的应用价值 目 录中文摘要......................................................................................................................I英文摘要.....................................................................................................................II前言...............................................................................................................................11 材料与方法............................................................................................................21.1 病例来源.............................................................................................................21.2 试剂与仪器........................................................................................................21.3 方法......................................................................................................................21.4 统计学方法........................................................................................................22 结果..........................................................................................................................32.1 两组血清Cyc、β2-MG含量的比较...........................................................32.2 两项指标单一检测与联合检测阳性率的比较.......................................32.3 单一检测与联合检测灵敏度与特异度的比较.......................................43 讨论..........................................................................................................................5结论...............................................................................................................................7参考文献.....................................................................................................................8致谢...............................................................................................................................9综述.............................................................................................................................10摘 要目的 探讨在糖尿病肾病患者血清中联合检测Cyc和β2-MG含量对早期诊断的临床应用价值。

方法 选择2016年1月至2017年1月在南华大学附属第一医院住院确诊为糖尿病肾病的60例患者作为实验对象，设为研究组选择同一时间段在南华大学附属第一医院接受体检的60例正常健康者，设为对照组对比在单项检测时研究组与对照组两组患者血清中的Cyc和β2-MG的含量，和联合检测时血清中的阳性率，特异度与敏感度结果 在对糖尿病肾病的临床诊断中，糖尿病肾病患者血清中Cyc与β2-MG含量显著升高两组相比较，其检验差异有统计学意义（P<0.05);其中，研究组患者血清中Cyc的阳性率为73.3%，β2-MG的阳性率为58.3 %，两者联合检测的阳性率高达90.0%联合检测糖尿病肾病患者血清Cyc与β2-MG的阳性率与灵敏度均明显高于其单项检测，差异均具有统计学意义（P<0.05）；但其特异度无明显差别，差异无统计学意义(P>0.05)结论 通过对血清Cyc与β2-MG的检测，发现其是诊断糖尿病肾病早期诊断的重要指标，联合检测有利于提高患者的检出率，具有较高的临床价值关键词：胱抑素C；β2-微球蛋白；糖尿病肾病ABSTRACTObjective: To explore the clinical value of joint detection of Cyc and β2-MG in blood in early diagnosis of diabetic nephropathy. Methods 60 patients with diabetic nephropathy in our hospital from January 2016 to January 2017 were selected as the research group.Meanwhile,60 healthy people after physical examination in our hospital were selected as the control group.The levels of Cyc and β2-MG in two groups was observed and compared respectively with the positive rate,specificity and sensitivity between single detection and joint detection.Results the levels of Cyc and β2-MG in blood in research group was obviously higher than those in the control group,there was a statistical difference between two groups(P<0.05).Among them,The positive detection rate of Cyc was 73.3%,and the positive detection rate of β2-MG was 58.3% , in patients of research group.The positive rate of joint detection of these two indicators was as high as 90.0%.The positive rate and sensitively of joint detection was obviously higher than that of any single detection ,and there was a statistical difference (P<0.05).There was basically in coincidence between single detection and the joint detection and was no statistical difference among them (P>0.05).Conclusion It is an important indicators in the early diagnosis of diabetic nephropathy by Cyc and β2-MG detection,And the combination of two ways can significantly improve the detection rate of patients and is worthy of clinical application .key words：Cys-c;β2-MG;Diabetic nephropathy前 言糖尿病(diabetes mellitus，DM)是一组以高血糖为特征的慢性代谢性疾病，多由遗传和环境因素共同作用引起。

糖尿病肾病(Diabetic nephropathy，DN)是糖尿病最常见的微血管病变之一，是引起慢性肾脏病变以及导致终末期肾病的主要原因［1］，也是引起糖尿病患者终末期肾功能衰竭的重要原因［2］临床表现多为高血压、蛋白尿与肾功能逐渐减退 多数糖尿病肾病患者早期无明显的临床症状，诊断困难而在早期肾脏已开始发生病理改变，若当临床检测出蛋白尿时，肾脏损伤已不可逆转因此，早期诊断、早期鉴别、早期治疗、改善患者的机体状况是提高糖尿病肾病患者生存率的关键[3]目前，临床多采用肌酐、尿素氮及尿白蛋白排除率（UAER）等传统检测指标，但这些传统检测指标难以判断糖尿病患者的早期肾脏损伤如UAER 易受运动、血压、尿路感染、月经以及酮体的状态等等因素的影响肾脏活检能发现早期肾脏损伤的组织学变化，而临床症状却多不明显，且常规的肾功能检测和尿液常规多为正常[4]Cyc是一种半胱氨酸蛋白酶抑制剂，广泛存在于机体组织的有核细胞和体液内，是一种低分子量，碱性非糖化蛋白质产生率稳定，循环中的Cyc仅通过肾小球滤过清除，不受性别、年龄、饮食及肿瘤等等因素的影响正常情况下循环中的Cyc自由的通过肾小球滤过膜，并且在近曲小管进行重吸收和降解，而通过肾小球滤过膜的Cyc也不会返回血流中。

因此，血清中的Cyc含量在一定程度上能反应肾小球滤过率，是反映早期肾功能损伤的有效指标之一［5－6］β2-MG是一种小分子球蛋白，广泛存在于机体淋巴细胞、血小板、多形核白细胞分子量为11800，由99个氨基酸组成的单肽多链正常人β2-MG的合成率以及释放量较为稳定,且分子量小，不和血浆蛋白结合，99.9%被肾小球滤过在近曲小管重吸收降解，故而正常情况下机体β2-MG的排出极微量且β2-MG含量不受性别、年龄等因素的影响，因此，血清中β2-MG含量升高可在一定程度上反应肾小球滤过功能损伤或滤过负荷增加是反映早期肾脏功。