Lee Byung-Wan, Ihm Sung-Hee, Choi Moon-Gi, Yoo Hyung-Joon
Division of Endocrinology and Metabolism, College of Medicine, University of Hallym, 94-200 Yeongdeungpo-Dong Yeongdeungpo-Gu, Seoul 150-030, Republic of Korea.
Diabetes Res Clin Pract. 2007 Dec;78(3):428-34. doi: 10.1016/j.diabres.2007.06.015. Epub 2007 Sep 5.
In a clinic-based, cross-sectional study of 320 type 2 diabetic patients, we staged the level of diabetic nephropathy (normoalbuminuric, microalbuminuric and macroalbuminuric stage) and estimated GFR based on serum creatinine and cystatin C (CysC). Serum creatinine and CysC levels were 0.91+/-0.21 mg/dL and 0.87+/-0.26 mg/L, respectively. Correlation coefficients between CysC-GFR and each of the creatinine-based GFR measurements (MDRD-GFR, Cockcroft-Gault-GFR, and CLcr) were 0.589, 0.569, and 0.479 (p<0.001). Serum CysC was significantly lower in normoalbuminurics (0.83+/-0.22) than in microalbuminurics and macroalbuminurics (0.94+/-0.33 and 1.05+/-0.28; p=0.004 and p<0.001). Of the estimations of GFR, significant differences among the groups were found on CysC-GFR and CLcr. CysC-GFR (mL/min) was statistically lower in macroalbuminurics (79.5+/-30.5) than in normoalbuminurics (104.3+/-30.9, p=0.01). The logistic regression analyses showed that retinopathy, A1C, CysC, diabetic duration, and CysC-GFR were indicators to predict the development of microalbuminuria. Serum CysC seems to be more accurate serum marker than serum creatinine in evaluating a prognostic stage of type 2 diabetic nephropathy. Our study suggests that, in Korean type 2 diabetic patients, CysC-based GFR might be more valuable than creatinine-based GFR in the prediction of the microalbuminuric stage.
在一项以诊所为基础的对320例2型糖尿病患者的横断面研究中，我们对糖尿病肾病的水平进行了分期（正常白蛋白尿期、微量白蛋白尿期和大量白蛋白尿期），并根据血清肌酐和胱抑素C（CysC）估算肾小球滤过率（GFR）。血清肌酐和CysC水平分别为0.91±0.21mg/dL和0.87±0.26mg/L。CysC-GFR与基于肌酐的各GFR测量值（MDRD-GFR、Cockcroft-Gault-GFR和肌酐清除率[CLcr]）之间的相关系数分别为0.589、0.569和0.479（p<0.001）。正常白蛋白尿患者的血清CysC（0.83±0.22）显著低于微量白蛋白尿患者和大量白蛋白尿患者（0.94±0.33和1.05±0.28；p=0.004和p<0.001）。在GFR的估算中，各分组在CysC-GFR和CLcr方面存在显著差异。大量白蛋白尿患者的CysC-GFR（mL/min）（79.5±30.5）在统计学上低于正常白蛋白尿患者（104.3±30.9，p=0.01）。逻辑回归分析表明，视网膜病变、糖化血红蛋白（A1C）、CysC、糖尿病病程和CysC-GFR是预测微量白蛋白尿发生的指标。在评估2型糖尿病肾病的预后阶段时，血清CysC似乎是比血清肌酐更准确的血清标志物。我们的研究表明，在韩国2型糖尿病患者中，基于CysC的GFR在预测微量白蛋白尿期方面可能比基于肌酐的GFR更有价值。
