Cystatin C 在早期糖尿病腎病變之研究

The Study of Cystatin C in Early Diabetic Nephropathy

楊宜瑱(Yi-Sun Yang)

指導教授 ： 黃建寧

中山醫學大學/醫學院/醫學研究所/碩士(2007年)

https://doi.org/10.6834/CSMU.2007.00072

摘要

目的: 雖然過去已經有血清cystatin C的測量與臨床上以其評估糖尿病患者腎絲球過濾率的相關研究發表，然而那些研究並未採用慢性腎臟疾病腎絲球過濾率分期系統，因此我們針對第2型糖尿病患者進行本研究，希望採用美國國家腎病治療品質指南之慢性腎臟疾病分期系統，藉以了解應用血清cystatin C來偵測腎絲球過濾率在初期的下降的價值。
方法：本研究於中山醫學大學附設醫院收收錄研究樣本。每位收錄研究個案採集早晨空腹血液與尿液以測量其代謝參數基礎值、血清肌酸酐、血清cystatin C和尿液的白蛋白-肌酸酐比值(albumin-creatinine ratio)。並使用Cockcroft-Gault 肌酸酐廓清率公式計算腎絲球過濾率。
結果：本研究共收集符合研究條件的個案組102人。102位第2型糖尿病患者中，分別有67、25及10位分別為尿蛋白正常、微量蛋白尿及巨量蛋白尿。使用血清cystatin C偵測初期腎絲球過濾率降低的效果優於使用血清肌酸酐。對於第1期和第2期慢性腎臟疾病(Cockcroft-Gault肌酸酐廓清率臨界值分別為90 ml/min和60 ml/min)而言，使用血清cystatin C的診斷正確性較血清肌酸酐高。此外血清cystatin C值還跟尿液白蛋白的排除量有關，而血清肌酸酐則否。
結論：目前Cockcroft-Gault公式還是評估腎功能最可靠且較便宜的方式。然而，我們的研究結果(和其他研究相當)顯示血清cystatin C值也許可以取代血清肌酸酐用來提早偵測腎臟功能輕微受損的患者，也有機會可以成為第型2糖尿病患者初期腎絲球功能障礙之指標，尤其是用來偵測初期的腎功能減退，或是當肌酸酐或尿蛋白測量有困難時還優於血清肌酸酐。

關鍵字

腎絲球過濾率 ； 血清cystatin C值 ； 白蛋白-肌酸酐比值 ； 慢性腎臟疾病 ； 糖尿病腎病變

並列摘要

Background:
The estimation of serum cystatin C and its practical use for the estimation of the glomerular filtration rate (GFR) in diabetic patients has been previously demonstrated; however, those studies did not use the chronic kidney disease GFR staging. Therefore, we performed this study in type 2 diabetic patients with the aim to examine the usefulness of serum cystatin C to detect early decline of GFR using the staging of
chronic kidney disease defined by the Kidney Disease Outcomes Quality Initiative guideline.
Methods: A total of 102 Taiwanese type 2 diabetic patients were recruited from the Chung-Shan Medical University Hospital. Morning fasting blood and urine samples were obtained for basal metabolic parameters, serum creatinine, serum cystatin C, and albumin-creatinine ratio. GFR was determined by Cockcroft-Gault equation creatinine clearance (CG-CCr).
Results: Of the 102 type 2 diabetic patients, 67, 25, and 10 had normo-, micro-, and macroalbuminuria, respectively. Serum cystatin C was superior to serum creatinine in detecting early decline of GFR. The diagnostic accuracy of serum cystatin C was better than serum creatinine for stage 1 and 2 chronic kidney disease (CG-CCr cut-off value of 90 ml/min and 60 ml/min). Furthermore, serum cystatin C was also correlated with urine albumin excretion, which was not true with serum creatinine.
Conclusions: These results suggest that serum cystatin C may be an alternative serum marker for the early identification of subjects with a slight reduction of renal function, and also it may be a marker for early glomerular dysfunction in type 2 diabetes.

並列關鍵字

Glomerular filtration rate ； serum cystatin C ； chronic kidney disease ； creatinine clearance ； diabetic nephropathy

參考文獻

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