胱抑素C与同型半胱氨酸在糖尿病早期肾功能损害及中医证型间相关性分析
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摘要
目的:探讨胱抑素C与同型半胱氨酸在糖尿病早期肾功能损害及中医证型间的相关性分析。方法:选择2016年1月—12月2型糖尿病患者302例,按尿微量白蛋白排泄率分为单纯糖尿病组(A组),早期糖尿病肾病组(B组),选取辽宁中医药大学附属医院体检中心120例体检健康者作为对照组;对早期糖尿病肾病按中医证型分组,对各组指标进行统计对比分析。结果:CysC、Hcy在糖尿病早期肾功能损害患者血清中升高明显,与单纯糖尿病组和对照组比较,差异有统计学意义(P<0.05);单项指标检测阳性率相对较低,二者联合检测阳性率大于单项检测阳性率;早期糖尿病肾病患者中气阴两虚证发生率最高(46.75%),其次为阴虚燥热(33.13%)及脾虚湿困(20.12%),3组与对照组比较CysC、Hcy升高明显,差异有统计学意义(P<0.05),阴虚燥热组和气阴两虚组患者的CysC、Hcy差异无统计学意义(P>0.05),脾虚湿困组与阴虚燥热和气阴两虚组比较CysC、Hcy明显升高,差异有统计学意义(P<0.05)。结论:在糖尿病早期肾功能损害患者血清中CysC、Hcy升高明显,且联合检测提高糖尿病肾病的早期诊断率,其水平与中医证型可能存在一定的相关性,可作为早期糖尿病肾病诊断和中医辨证分型的参考指标。
Objective:To analyze the correlation between cystatin C and homocysteine in early diabetic renal impairment and TCM syndrome type. Methods:302 cases of patients with type 2 diabetes from January to 12 months in 2016 in our hospital,according to urinary albumin excretion rate divided into diabetes mellitus group(A group),early diabetic nephropathy group(B group),and select the hospital medical examination center of 120 healthy persons as control group,and the early stage of diabetic nephropathy group by TCM card type,by statistical comparative analysis of each index. Results:CysC and Hcy in early diabetic renal damage in patients increased significantly,and compared with the simple diabetic group and healthy control group,the difference was statistically significant(P<0.05);the positive rate of detection of individual index was relatively low,the positive rate of combined detection of the two was greater than the positive rate of single test;In early diabetic nephropathy patients,the incidence of deficiency of Qi and Yin was the highest(46.75%),followed by Yin-deficiency and dryness-heat(33.13%)and spleen deficiency and dampness-retention(20.12%),compared with the control group,the three groups increased significantly in CysC and Hcy,and the difference was statistically significant(P<0.05),there was no significant difference in CysC and Hcy between Yin-deficiency and dryness-heat group and Qiyin deficiency group(P>0.05). CysC and Hcy in spleen deficiency and dampness-retention group were significantly higher than those in Yin-deficiency and dryness-heat group and Qi-yin deficiency group(P<0.05). Conclusion:In diabetic early renal damage in patients with CysC and Hcy increased significantly,and the combined detection could improve the rate of early diagnosis of diabetic nephropathy,there is a certain correlation with the level of TCM syndrome type,can be used as a reference index for the early diagnosis of diabetic nephropathy and TCM syndrome type.
Objective:To analyze the correlation between cystatin C and homocysteine in early diabetic renal impairment and TCM syndrome type. Methods:302 cases of patients with type 2 diabetes from January to 12 months in 2016 in our hospital,according to urinary albumin excretion rate divided into diabetes mellitus group(A group),early diabetic nephropathy group(B group),and select the hospital medical examination center of 120 healthy persons as control group,and the early stage of diabetic nephropathy group by TCM card type,by statistical comparative analysis of each index. Results:CysC and Hcy in early diabetic renal damage in patients increased significantly,and compared with the simple diabetic group and healthy control group,the difference was statistically significant(P<0.05);the positive rate of detection of individual index was relatively low,the positive rate of combined detection of the two was greater than the positive rate of single test;In early diabetic nephropathy patients,the incidence of deficiency of Qi and Yin was the highest(46.75%),followed by Yin-deficiency and dryness-heat(33.13%)and spleen deficiency and dampness-retention(20.12%),compared with the control group,the three groups increased significantly in CysC and Hcy,and the difference was statistically significant(P<0.05),there was no significant difference in CysC and Hcy between Yin-deficiency and dryness-heat group and Qiyin deficiency group(P>0.05). CysC and Hcy in spleen deficiency and dampness-retention group were significantly higher than those in Yin-deficiency and dryness-heat group and Qi-yin deficiency group(P<0.05). Conclusion:In diabetic early renal damage in patients with CysC and Hcy increased significantly,and the combined detection could improve the rate of early diagnosis of diabetic nephropathy,there is a certain correlation with the level of TCM syndrome type,can be used as a reference index for the early diagnosis of diabetic nephropathy and TCM syndrome type.
引文
[1]李平,谢院生.糖尿病肾病中西医结合研究基础与临床[M].上海:上海科学技术出版社,2009:344-349.
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[12]王寒啸.血浆同型半胱氨酸与糖尿病肾病发生发展过程相关性研究[J].广西中医药大学学报,2014,17(1):51.
[13]姚建,陈名道.糖尿病肾病及其早期防治[J].中国地方病防治杂志,2017,32(8):938-940.
[14]王堃,刘炼华,吴琼,等.临床常见检测指标在糖尿病慢性肾脏疾病中的应用价值分析[J].中国糖尿病杂志,2016,24(7):601-605.
[15]郭凯锋,陈海冰,贾伟平.糖尿病肾赃疾病的流行病学进展[J].医学研究杂志,2015(3):162-166.
[16]苏克雷,朱垚,贾晓巧,等.糖尿病肾病病名探源及病机述评[J].辽宁中医药大学学报,2012,14(1):88-90.
[17]康路,马济佩.名老中医对糖尿病肾病证型认识的文献分析[J].辽宁中医药大学学报,2011,13(10):113-115.
[18]王雅萍,王琛.2型搪尿病患者糖尿病肾病的发病率及中医证型分布特点分析[J].亚太传统医药,2013,9(2):104-105.
[19]武曦蔼.2型糖尿病肾病的中医证候研究[D].北京:北京中医药大学,2007.
[20]齐铮,赵进喜,王硕仁,等.糖尿病肾病中医证候分布规律的文献研究[J].环球中医药,2012,5(12):914-917.
[2]许庭松,孙奕.超敏超敏C反应蛋白、胱抑素C和同型半胱氨酸联合检测在糖尿病早期肾损害中的诊断价值[J].国际检验医学杂志,2017,38(4):553-554.
[3]American Diabetes Association. Standards of medical care indiabetes—2014[J]. Diabetes Care,2014,37(1):S14-S80.
[4]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志,2014,22(8):40-42.
[5]中华医学会糖尿病学分会糖尿病慢性并发症调查组.全国住院糖尿病患者慢性并发症及其相关危险因素10年回顾性调查分析[J].中国糖尿病杂志,2003,11(4):5-10.
[6]中华中医药学会肾病分会.糖尿病肾病诊断、辨证分型及疗效评定标准[J].上海中医药杂志,2007,41(7):7-8.
[7]KatoM,NatarajanR.Diabeticnephropathy—emerging epigeneticmechanisms[J]. Nature Rev Nephrol,2014,10(9):517-530.
[8]李勇杰,汪凌霄,张建飞,等.同型半胱氨酸联合胱抑素C对早期糖尿病肾病的诊断价值分析[J].中国卫生检验杂志,2017,27(17):524-526.
[9]朱圣军,汪骅.多项生化检测指标对早期糖尿病肾病的诊断价值[J].实验与检验医学,2015,33(4):503-505.
[10]邱军.胱抑素C、同型半胱氨酸和β2微球蛋白在糖尿病肾病早期的检测价值[J].糖尿病新世界,2016,19(18):49-50.
[11]周远青,梁瑞莲,谢健敏,等.糖尿病肾病患者血清胱抑素C和β2微球蛋白及尿微量白蛋白/尿肌酐比值与尿蛋白的相关性[J].中国慢性病预防与控制,2012,20(4):405-407.
[12]王寒啸.血浆同型半胱氨酸与糖尿病肾病发生发展过程相关性研究[J].广西中医药大学学报,2014,17(1):51.
[13]姚建,陈名道.糖尿病肾病及其早期防治[J].中国地方病防治杂志,2017,32(8):938-940.
[14]王堃,刘炼华,吴琼,等.临床常见检测指标在糖尿病慢性肾脏疾病中的应用价值分析[J].中国糖尿病杂志,2016,24(7):601-605.
[15]郭凯锋,陈海冰,贾伟平.糖尿病肾赃疾病的流行病学进展[J].医学研究杂志,2015(3):162-166.
[16]苏克雷,朱垚,贾晓巧,等.糖尿病肾病病名探源及病机述评[J].辽宁中医药大学学报,2012,14(1):88-90.
[17]康路,马济佩.名老中医对糖尿病肾病证型认识的文献分析[J].辽宁中医药大学学报,2011,13(10):113-115.
[18]王雅萍,王琛.2型搪尿病患者糖尿病肾病的发病率及中医证型分布特点分析[J].亚太传统医药,2013,9(2):104-105.
[19]武曦蔼.2型糖尿病肾病的中医证候研究[D].北京:北京中医药大学,2007.
[20]齐铮,赵进喜,王硕仁,等.糖尿病肾病中医证候分布规律的文献研究[J].环球中医药,2012,5(12):914-917.