血清胱抑素C、同型半胱氨酸联合检测对诊断高血压早期肾病的意义

目的：探讨血清胱抑素C（CysC）、同型半胱氨酸（Hcy）联合检测在诊断高血压早期肾病的临床价值。方法选取2012年6月至2014年6月该院高血压患者393例，根据患者肾小球滤过率（GFR），将其分为A组单纯性高血压（89例）、B组高血压肾病Ⅰ～Ⅱ期（194例）、C组高血压肾病Ⅲ～Ⅴ期（110例）。选取同期健康体检者为健康对照组（213例），检测血清CysC、Hcy、肌酐（Cr）的含量，并对检测结果进行比较分析。结果血清CysC、Hcy和Cr含量随着高血压肾病患者病情的加重而呈上升趋势，A组CysC、Cr含量与健康对照组相比，差异无统计学意义（P＞0．05），A、B、C组 Hcy含量和B、C组CysC、Cr含量均高于健康对照组（P＜ 0．05）。ROC曲线分析显示，B组CysC、Hcy、Cr的 AUC分别为0．897、0．934、0．983，C组分别为0．995、0．992、1．000。B组的CysC、Hcy、Cr阳性率分别为69．59％、64．43％、4．12％，血清Cr＋ Hcy、Cr＋CysC、Hcy＋CysC、Cr＋ Hcy＋CysC联合检出率分别为65．46％、69．59％、89．18％、90．21％；C组CysC、Hcy、Cr的阳性率分别为98．18％、95．45％、95．45％，血清Cr＋ Hcy、Cr＋CysC、Hcy＋CysC、Cr＋ Hcy＋CysC联合检出率分别为100．00％、98．18％、100．00％、100．00％。结论 CysC、Hcy、Cr均可作为诊断高血压肾病的生物标志物；CysC和 Hcy联合检测高血压肾病Ⅰ～Ⅱ期，具有较高的灵敏度，对诊断早期高血压肾病具有一定的临床意义。

The value of combined detection of serum cystatin C and homocysteine in the early hypertensive nephropathy

Objective To investigate the clinical significance of combined detection of serum cystatin C(CysC) and homocys-teine(Hcy) in early hypertensive nephropathy .Methods 393 hypertension outpatients or inpatients from June 2012 to June 2014 were selected as the research object .According to the glomerular filtration rate(GFR) ,they were divided into three groups ,namely A ,B and C .The A group was 89 patients with simple hypertension patients ,the B group consisted of 194 patients with hypertensive nephropathy patients with stage Ⅰ - Ⅱ ,and the C group consisted of 110 patients with hypertensive nephropathy patient with stageⅢ - Ⅴ .A total of 213 healthy people were selected as control group who did health examination in the same time .The concentra-tion of CysC ,Hcy ,Creatinine(Cr) in serum were detected in patients and healthy people respectively ,a comparative study of the de-termination results carried out .Results The concentration of serum CysC ,Hcy ,Cr showed a rising trend with the severity of hy-pertensive kidney disease .Compared with content of CysC ,Cr of A group and control group ,which had no significant difference (P>0 .05) ,the Hcy content of group A ,B ,C ,the CysC and Cr content of group B and C were higher than that the healthy control (P<0 .05) .ROC curves showed that the AUC of CysC ,Hcy and Cr in group B were 0 .897 ,0 .934 and 0 .983 ,while the AUC of CysC , Hcy and Cr in group C were 0 .995 ,0 .992 and 1 .000 .The positive rates of CysC ,Hcy and Cr in group B were 69 .59% ,64 .43%and 4 .12% ,and the relevance ratios in combination of Cr+ Hcy ,Cr+CysC ,Hcy+CysC ,Cr+ Hcy+Cys were 65 .46% ,69 .59% , 89 .18% and 90 .21% ;while those in group C were 98 .18% 95 .45% and 95 .45% ,100 .00% ,98 .18% ,100 .00% and 100 .00% in the relevance ratios in combination .Conclusion The concentrations of CysC ,Hcy and Cr in the patient′s serum could be used as bi-omarker for diagnosis of hypertensive nephropathy ,combined detection of CysC and Hcy concentration in the patients`serum could be used as a diadynamic criteria of hypertensive nephropathy with stage of Ⅰ - Ⅱ ,and also has high sensitivity ,had certain refer-ence value in the early diagnosis of hypertensive nephropathy .