Department of Nephrology, Ankara Education and Research Hospital, Ankara, Turkey.
J Clin Lab Anal. 2013 Jul;27(4):317-22. doi: 10.1002/jcla.21605.
The metabolic syndrome, syndrome X, is a group of metabolic disorders in which insulin resistance plays a pivotal role. The MS is an important risk factor for subsequent development of type 2 diabetes and cardiovascular disease. Fetuin-A is a liver derived blood protein that acts as effective inhibitor of soft tissue calcification. Cystatin C is a useful marker in measuring glomerular filtration rate. Moreover, recently it has been suggested that cystatin C may be a potential biomarker for detecting microalbuminuria. Microalbuminuria (MA) is a strong indicator of morbidity related to cardiovascular disorders, and is currently considered a novel diagnostic criterion for MS. It has been also demonstrated that the increased serum fetuin-A levels is associated with several parameters of MS. In this study, we attempted to investigate the relationship between serum fetuin-A, cystatin-C levels and microalbuminuria in patients with MS.
A total of 50 patients with MS and 25 control were included in this study. We defined MS by the NCEP criteria among nondiabetic outpatients. Patients with MS were further divided into two groups based on MA status. Overall 25 of the participants with MS did not have MA (group I), while the remaining 25 had MA (group II). None of the subjects in the healthy control group (group III) had laboratory findings supporting the presence of MA. The serum fetuin-A and cystatin-C levels were measured using ELISA.
Age, distributions of sex, BP and LDL cholesterol levels were similar among all groups. BMI, Waist/hip ratio, FBG, HOMA-IR, total cholesterol, trigliserid, CRP levels were significantly higher in group I and group II compared to control. In group II, the cystatin-C and fetuin levels were higher than control. While the cystatin-C levels were higher in group II compared to group I, the fetuin levels did not different. Morever, the fetuin A and cystatin-C concentrations were positively correlated with microalbuminuria (r = 0.26, p = 0.02; r = 0.50, p = 0.0001, respectively).
In our study, we found that MS patients with microalbuminuria had high levels of fetuin-A and cystatin-C. In conclusion, we suggest that determination of fetuin-A and cystatin C levels could be useful marker as an early indicator of renal injury in patients with MS.
代谢综合征，又称综合征 X，是一组代谢紊乱，其中胰岛素抵抗起着关键作用。MS 是随后发展为 2 型糖尿病和心血管疾病的重要危险因素。胎球蛋白-A 是一种肝脏来源的血液蛋白，可有效抑制软组织钙化。胱抑素 C 是衡量肾小球滤过率的有用标志物。此外，最近有人提出，胱抑素 C 可能是检测微量白蛋白尿的潜在生物标志物。微量白蛋白尿（MA）是与心血管疾病相关发病率的一个强有力指标，目前被认为是 MS 的一种新的诊断标准。已经证明，血清胎球蛋白-A 水平升高与 MS 的几个参数有关。在这项研究中，我们试图研究 MS 患者血清胎球蛋白-A 和胱抑素 C 水平与微量白蛋白尿之间的关系。
本研究共纳入 50 例 MS 患者和 25 例对照组。我们根据非糖尿病门诊患者的 NCEP 标准定义 MS。根据 MA 状态，将 MS 患者进一步分为两组。共有 25 例 MS 患者没有 MA（组 I），而其余 25 例患者有 MA（组 II）。健康对照组（组 III）的所有受试者均无实验室发现支持 MA 存在。使用 ELISA 法测定血清胎球蛋白-A 和胱抑素-C 水平。
所有组的年龄、性别分布、血压和 LDL 胆固醇水平相似。BMI、腰围/臀围、FBG、HOMA-IR、总胆固醇、三酰甘油、CRP 水平在组 I 和组 II 均显著高于对照组。在组 II 中，胱抑素 C 和胎球蛋白水平高于对照组。虽然组 II 中的胱抑素-C 水平高于组 I，但胎球蛋白水平没有差异。此外，胎球蛋白 A 和胱抑素-C 浓度与微量白蛋白尿呈正相关（r = 0.26，p = 0.02；r = 0.50，p = 0.0001）。
在我们的研究中，我们发现有微量白蛋白尿的 MS 患者胎球蛋白-A 和胱抑素-C 水平较高。总之，我们认为测定胎球蛋白-A 和胱抑素 C 水平可能是 MS 患者早期肾功能损伤的有用标志物。
