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研究生:楊宜瑱
研究生(外文):Yi-Sun
論文名稱:Cystatin C 在早期糖尿病腎病變之研究
論文名稱(外文):The Study of Cystatin C in Early Diabetic Nephropathy
指導教授:黃建寧黃建寧引用關係
指導教授(外文):Chien-Ning Huang
學位類別:碩士
校院名稱:中山醫學大學
系所名稱:醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:41
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目的: 雖然過去已經有血清cystatin C的測量與臨床上以其評估糖尿病患者腎絲球過濾率的相關研究發表,然而那些研究並未採用慢性腎臟疾病腎絲球過濾率分期系統,因此我們針對第2型糖尿病患者進行本研究,希望採用美國國家腎病治療品質指南之慢性腎臟疾病分期系統,藉以了解應用血清cystatin C來偵測腎絲球過濾率在初期的下降的價值。
方法:本研究於中山醫學大學附設醫院收收錄研究樣本。每位收錄研究個案採集早晨空腹血液與尿液以測量其代謝參數基礎值、血清肌酸酐、血清cystatin C和尿液的白蛋白-肌酸酐比值(albumin-creatinine ratio)。並使用Cockcroft-Gault 肌酸酐廓清率公式計算腎絲球過濾率。
結果:本研究共收集符合研究條件的個案組102人。102位第2型糖尿病患者中,分別有67、25及10位分別為尿蛋白正常、微量蛋白尿及巨量蛋白尿。使用血清cystatin C偵測初期腎絲球過濾率降低的效果優於使用血清肌酸酐。對於第1期和第2期慢性腎臟疾病(Cockcroft-Gault肌酸酐廓清率臨界值分別為90 ml/min和60 ml/min)而言,使用血清cystatin C的診斷正確性較血清肌酸酐高。此外血清cystatin C值還跟尿液白蛋白的排除量有關,而血清肌酸酐則否。
結論:目前Cockcroft-Gault公式還是評估腎功能最可靠且較便宜的方式。然而,我們的研究結果(和其他研究相當)顯示血清cystatin C值也許可以取代血清肌酸酐用來提早偵測腎臟功能輕微受損的患者,也有機會可以成為第型2糖尿病患者初期腎絲球功能障礙之指標,尤其是用來偵測初期的腎功能減退,或是當肌酸酐或尿蛋白測量有困難時還優於血清肌酸酐。


Background:
The estimation of serum cystatin C and its practical use for the estimation of the glomerular filtration rate (GFR) in diabetic patients has been previously demonstrated; however, those studies did not use the chronic kidney disease GFR staging. Therefore, we performed this study in type 2 diabetic patients with the aim to examine the usefulness of serum cystatin C to detect early decline of GFR using the staging of
chronic kidney disease defined by the Kidney Disease Outcomes Quality Initiative guideline.
Methods: A total of 102 Taiwanese type 2 diabetic patients were recruited from the Chung-Shan Medical University Hospital. Morning fasting blood and urine samples were obtained for basal metabolic parameters, serum creatinine, serum cystatin C, and albumin-creatinine ratio. GFR was determined by Cockcroft-Gault equation creatinine clearance (CG-CCr).
Results: Of the 102 type 2 diabetic patients, 67, 25, and 10 had normo-, micro-, and macroalbuminuria, respectively. Serum cystatin C was superior to serum creatinine in detecting early decline of GFR. The diagnostic accuracy of serum cystatin C was better than serum creatinine for stage 1 and 2 chronic kidney disease (CG-CCr cut-off value of 90 ml/min and 60 ml/min). Furthermore, serum cystatin C was also correlated with urine albumin excretion, which was not true with serum creatinine.
Conclusions: These results suggest that serum cystatin C may be an alternative serum marker for the early identification of subjects with a slight reduction of renal function, and also it may be a marker for early glomerular dysfunction in type 2 diabetes.


誌 謝 I
論文摘要 I
英文摘要 IV
目 錄 VI
圖表目錄 VII
附錄目錄 VIII
第一章 緒論 1
第一節 背景與目的 1
第二節 文獻回顧 4
第二章 材料與方法 13
第一節 研究對象 13
第二節 資料收集 13
第三節 統計分析 16
第三章 結果 16
第四章 討論 20
第五章 結論與建議 23
參考文獻 25
附錄………………………………………………………………………………….40

圖表目錄
表一 基本資料………………………………………………………………………31
表二 血清肌酸酐與血清cystatin C在年齡、性別、體積之比較..……………31
表三 依照微量白蛋白尿及慢性腎臟疾病分期,比較血清肌酸酐與血清cystatin C之平均值…………………………………………………………………………...32
表四 Cockcroft-Gault-肌酸酐廓清率與血清肌酸酐、血清cystatin C以及肌酸酐廓清率之關連性…………………………………………………………………..32
表五 血清cystatin C、清肌酸酐、CG-肌酸酐廓清率、白蛋白:肌酸酐比值之18個月後追蹤之平均值比較……………………………….………………………33
圖一(A)研究參數之診斷準確性的ROC曲線分析以及血清肌酸酐和血清cystatin C在診斷慢性腎臟疾之敏感度與專一性的比較:慢性腎臟疾分期2和3的比較.34
圖一(B)研究參數之診斷準確性的ROC曲線分析以及血清肌酸酐和血清cystatin C在診斷慢性腎臟疾之敏感度與專一性的比較:慢性腎臟疾分期1和2的比較.35
圖二 (A)追蹤18個月有CG-肌酸酐廓清率下降的CG-肌酸酐廓清率圖示……..36
圖二 (B)追蹤18個月有CG-肌酸酐廓清率下降的血清cystatin C之比較……37
圖二 (C)追蹤18個月有CG-肌酸酐廓清率下降的血清清肌酸酐之比較……….38
圖二 (D) 追蹤18個月有CG-肌酸酐廓清率下降的白蛋白:肌酸酐比值之比較39

附錄目錄
附圖一腎臟醫學會透析病患(ESRD)2006年年度報告………………………… 40
附表一 慢性腎臟疾病之分期…………………………………………….…………41
附表二 微量白蛋白尿之分期………………………..……………………………41


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