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胱抑素C在1型糖尿病儿童和青少年肾损伤中的作用：一项系统评价

The role of cystatin C in kidney injury in children and adolescents with type 1 diabetes mellitus: a systematic review.

作者信息

Gkiourtzis Nikolaos, Stoimeni Anastasia, Michou Panagiota, Moutafi Maria, Cheirakis Konstantinos, Christakopoulos Aristeidis, Glava Agni, Panagopoulou Paraskevi, Tsigaras Georgios, Galli-Tsinopoulou Assimina, Christoforidis Athanasios, Tramma Despoina

机构信息

Aristotle University of Thessaloniki, Faculty of Health Sciences, School of Medicine, 4th Department of Pediatrics, Papageorgiou General Hospital, Thessaloniki, Greece.

Aristotle University of Thessaloniki, Faculty of Health Sciences, School of Medicine, Program of Postgraduate Studies Adolescent Medicine and Adolescent Health Care, Thessaloniki, Greece.

出版信息

J Bras Nefrol. 2025 Oct-Dec;47(4):e20240236. doi: 10.1590/2175-8239-JBN-2024-0236en.

DOI:10.1590/2175-8239-JBN-2024-0236en
PMID:40825227
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12360829/
Abstract

INTRODUCTION

Diabetic kidney disease (DKD) is a major complication of type 1 diabetes mellitus (T1D). In clinical practice, albuminuria and reduced estimated glomerular filtration rate (eGFR) are the main characteristics of DKD. Later studies revealed that interstitial damage is also observed as DKD occurs. Therefore, the application of a biomarker for early DKD detection was critical. This systematic review aimed to summarize the literature about the prognostic role of cystatin C in kidney injury in children and adolescents with T1D.

METHODS

From inception until September 24, 2024, an extensive literature search through major databases (MEDLINE/PubMed, Cochrane Library, and Scopus) was carried out to investigate the prognostic role of cystatin C in kidney injury in pediatric patients with T1D. The mean difference was used for continuous outcomes with 95%CI. A p < 0.05 was considered statistically significant. A quality assessment of included studies was conducted using the Newcastle-Ottawa Scale.

RESULTS

We included eleven studies with 2199 participants in this systematic review. The meta-analysis included four studies. No statistically significant difference was observed in serum cystatin C levels between patients with T1D and the control group.

CONCLUSION

Although individual studies showed some benefit of using serum cystatin C for the prognosis of DKD in pediatric patients with T1D, the meta-analysis of included studies reached no statistical significance. Future clinical studies should focus on the prognostic role of cystatin C (serum and urinary) in identifying kidney injury in pediatric patients with T1D.

摘要

引言

糖尿病肾病（DKD）是1型糖尿病（T1D）的主要并发症。在临床实践中，蛋白尿和估算肾小球滤过率（eGFR）降低是DKD的主要特征。后来的研究表明，随着DKD的发生也会观察到间质损伤。因此，应用生物标志物进行DKD早期检测至关重要。本系统评价旨在总结关于胱抑素C在T1D儿童和青少年肾损伤中的预后作用的文献。

方法

从开始到2024年9月24日，通过主要数据库（MEDLINE/PubMed、Cochrane图书馆和Scopus）进行了广泛的文献检索，以研究胱抑素C在T1D儿科患者肾损伤中的预后作用。连续结局采用均数差值及95%置信区间。p<0.05被认为具有统计学意义。使用纽卡斯尔-渥太华量表对纳入研究进行质量评估。

结果

本系统评价纳入了11项研究，共2199名参与者。荟萃分析纳入了4项研究。T1D患者与对照组之间的血清胱抑素C水平未观察到统计学显著差异。

结论

尽管个别研究显示使用血清胱抑素C对T1D儿科患者的DKD预后有一定益处，但纳入研究的荟萃分析未达到统计学意义。未来的临床研究应关注胱抑素C（血清和尿液）在识别T1D儿科患者肾损伤中的预后作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/fa3118b3d5ab/2175-8239-jbn-47-4-e20240236-gf10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/f6d2075bdf6f/2175-8239-jbn-47-4-e20240236-gf01.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/4b361493ea9e/2175-8239-jbn-47-4-e20240236-gf04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/1b3d47325f5c/2175-8239-jbn-47-4-e20240236-gf05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/cbcf383b2010/2175-8239-jbn-47-4-e20240236-gf06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/8041b386bf46/2175-8239-jbn-47-4-e20240236-gf07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/20203cf3fcd8/2175-8239-jbn-47-4-e20240236-gf08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/dcac6e38ffbe/2175-8239-jbn-47-4-e20240236-gf09.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/fa3118b3d5ab/2175-8239-jbn-47-4-e20240236-gf10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/f6d2075bdf6f/2175-8239-jbn-47-4-e20240236-gf01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/7ff30bdcceaa/2175-8239-jbn-47-4-e20240236-gf02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/545053707bf5/2175-8239-jbn-47-4-e20240236-gf03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/4b361493ea9e/2175-8239-jbn-47-4-e20240236-gf04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/1b3d47325f5c/2175-8239-jbn-47-4-e20240236-gf05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/cbcf383b2010/2175-8239-jbn-47-4-e20240236-gf06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/8041b386bf46/2175-8239-jbn-47-4-e20240236-gf07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/20203cf3fcd8/2175-8239-jbn-47-4-e20240236-gf08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/dcac6e38ffbe/2175-8239-jbn-47-4-e20240236-gf09.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd1/12360829/fa3118b3d5ab/2175-8239-jbn-47-4-e20240236-gf10.jpg

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本文引用的文献

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Cystatin C as a Marker of Kidney Function in Children.胱抑素 C 作为儿童肾功能的标志物。
Biomolecules. 2024 Aug 2;14(8):938. doi: 10.3390/biom14080938.
2
Cystatin C as an adjunct to HbA1c may prove useful in predicting the development of diabetic complications in children and adolescents with type 1 diabetes.胱抑素C作为糖化血红蛋白的辅助指标，可能有助于预测1型糖尿病儿童和青少年糖尿病并发症的发生。
J Diabetes Metab Disord. 2024 Apr 18;23(1):1251-1257. doi: 10.1007/s40200-024-01419-1. eCollection 2024 Jun.
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Should Cystatin C eGFR Become Routine Clinical Practice?
胱抑素 C eGFR 是否应成为常规临床实践？
Biomolecules. 2023 Jul 5;13(7):1075. doi: 10.3390/biom13071075.
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Novel Biomarkers of Diabetic Kidney Disease.糖尿病肾病的新型生物标志物。
Biomolecules. 2023 Mar 31;13(4):633. doi: 10.3390/biom13040633.
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ISPAD Clinical Practice Consensus Guidelines 2022: Microvascular and macrovascular complications in children and adolescents with diabetes.国际儿童青少年糖尿病研究学会2022年临床实践共识指南：糖尿病儿童和青少年的微血管和大血管并发症
Pediatr Diabetes. 2022 Dec;23(8):1432-1450. doi: 10.1111/pedi.13444.
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Childhood diabetes mellitus and early-onset kidney diseases later in life: a nationwide population-based matched cohort study.儿童期糖尿病与成年后早发肾脏疾病：基于全国人群的匹配队列研究。
BMC Med. 2022 Nov 8;20(1):428. doi: 10.1186/s12916-022-02634-4.
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Executive summary of the KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease: an update based on rapidly emerging new evidence.KDIGO 2022 慢性肾脏病糖尿病管理临床实践指南执行摘要：基于快速涌现的新证据的更新。
Kidney Int. 2022 Nov;102(5):990-999. doi: 10.1016/j.kint.2022.06.013.
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Cystatin C, renal resistance index, and kidney injury molecule-1 are potential early predictors of diabetic kidney disease in children with type 1 diabetes.胱抑素C、肾阻力指数和肾损伤分子-1是1型糖尿病儿童糖尿病肾病的潜在早期预测指标。
Front Pediatr. 2022 Jul 29;10:962048. doi: 10.3389/fped.2022.962048. eCollection 2022.
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