(3.238.130.97) 您好!臺灣時間:2021/05/14 18:49
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
: 
twitterline
研究生:胡美黛
研究生(外文):Mei-Tai
論文名稱:以血清cystatin C評估藥物對第二型糖尿病患腎功能之影響
論文名稱(外文):Application of serum cystatin C for evaluation the influence of different medicines on kidney function in type 2 diabetes patient
指導教授:周芬碧周芬碧引用關係
學位類別:碩士
校院名稱:中山醫學大學
系所名稱:生化暨生物科技研究所
學門:生命科學學門
學類:生物科技學類
論文種類:學術論文
論文出版年:2011
畢業學年度:99
語文別:中文
論文頁數:61
相關次數:
  • 被引用被引用:0
  • 點閱點閱:165
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
糖尿病腎病變(diabetic nephropathy, DN)是糖尿病最常見的併發症與死因,研究證實血清cystatin-C (胱蛋白C)對早期糖尿病腎病變的敏感性,比血清肌酸酐(creatinine)或以血清肌酸酐計算eGFR公式高1,2。目前關於藥物與早期糖尿病腎病變的文獻資料不多,各種藥物對早期糖尿病腎病變的影響亦不明確;本研究利用血清cystatin C評估第二型糖尿病患,使用降血糖藥物或合併降高血壓藥物後對早期糖尿病腎病變的影響。實驗中共收集125位第二型糖尿病患者,以免疫散射比濁法(immunonephelometry)測定血清cystatin C,計算Cys-eGFR (cystatin-C base estimates glomerular filtration rate),收集醣化血色素(glycosylated hemoglobin A1c, HbA1c)、腎臟及血脂常規項目及身體質量指數(body mass index, BMI) 等數據。實驗結果顯示男性的Cys-eGFR、尿液白蛋白與肌酸酐比值(albumin creatinine ratio, ACR)及高密度脂蛋白(high density lipoprotein cholesterol, HDL-C)較低;但血清肌酸酐(creatinine)及血清cystatin-C (p= 0.01)則較高,與女性糖尿病族群有明顯差異;年齡與血清cystatin-C呈正相關 (r=0.531, p<0.001),與Cys-eGFR則為負相關(r=0.549, p<0.001)。Cys-eGFR評估結果顯示,磺胺尿素類(sulfonylurea)的glibenclamide藥物(P = 0.003) 或乙型交感神經阻斷劑類(β1-blocker)降血壓藥物(P= 0.001)使用者的Cys-eGFR較低,與使用其他類別藥物者有顯著差異。以血清cystatin C篩檢糖尿病患腎臟功能,計算Cys-eGFR來評估腎絲球濾過率(glomerular filtration rate, GFR),應可提早提供初期腎功能減退時的警訊,對高危險群患者所使用藥物的更應謹慎評估。

Diabetic nephropathy is the most common complication of diabetes and cause of death. Studies showed that serum cystatin C has higher sensitivity for detection of early diabetic nephropathy than serum creatinine or serum creatinine base formula for calculated eGFR1,2. There are little literatures investigating the relationship between drug utilization and early diabetic nephropathy. The impact of variety of drugs on early diabetic nephropathy is not clear. This study used serum cystatin C to evaluation the impact of hypoglycemic drugs or lowering high blood pressure drugs on early diabetic nephropathy in 125 type II diabetes patients. Serum level of cystatin C was determined by immune nephelometry assay and used for calculation of Cys-eGFR. Usual blood data such as glycosylated hemoglobin, kidney function and blood lipids and body mass index were collected for analysis. The results showed that Cys-eGFR, urinary albumin creatinine ratio and high-density lipoprotein were lower in male than in female. On the other hand serum creatinine and serum cystatin C (p = 0.01) were significant higher in male than in female. The age of patients was positively correlated to serum cystatin C (r = 0.531, p <0.001), and negatively correlated to Cys-eGFR (r = 0.549, p <0.001). The users of sulfonylurea class drug, glibenclamide, and blood pressure lowering drugs of beta blocker class (β1-blocker) had lower Cys-eGFR as compared to those using other types of drugs with significances of P = 0.003 and P = 0.001 respectively. Application serum cystatin C for calculation of glomerular filtration rate (Cys-eGFR) for screening of kidney function in diabetic patients should be able to provide early warning sign of initial renal dysfunction for those drug users at high risk.

誌謝﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ Ⅰ
論文摘要﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ Ⅱ
英文摘要﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ Ⅳ
目錄﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ Ⅴ
圖表目錄﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ Ⅵ
附錄目錄﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ Ⅶ
名詞縮寫﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ Ⅷ
第一章 緒論﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 1
第一節 背景與目的﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 1
第二節 文獻回顧﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 6
第二章 材料與方法﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 20
第一節 研究對象﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 20
第二節 資料收集﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 20
第三節 統計分析﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 29
第三章 結果﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 31
第四章 討論﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 37
參考文獻﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 40
附錄﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒﹒ 46


1.Pucci L, Triscornia S, Lucchesi D, Fotino C, Pellegrini G, Pardini E, Miccoli R,Del Prato S, Penno G. Cystatin C and estimates of renal function: searching for a better measure of kidney function in diabetic patients. Clinical chemistry 53, 480-488 (2007).
2.McNamara NV, Chen R, Janu MR, Bwititi P, Car G, Seibel M. Early renal failure detection by cystatin C in type 2 diabetes mellitus: varying patterns of renal analyte expression. Pathology 41, 269-275 (2009).
3.International Diabetes Federation. Diabetes atlas (3rd edition). (2007).
4.Chan JC, Malik V, Jia W, Kadowaki T, Yajnik CS, Yoon KH, Hu FB. Diabetes in asia:epidemiology, risk factors, and pathophysiology.The journal of the american medical association 301, 2129-2140 (2009).
5.Chuang L,Tsai, S, Juang J, Tsai W, Tai T. Genetic epidemiology of type 1 diabetes mellitus in taiwan. Diabetes rearch and cinical pactice 50, S41–S47 (2000) .
6.慢性腎臟病防治手冊. (2007).
7.Yang WC, Hwang SJ. Incidence, revalence and mortality trends of dialysis end-stage renal disease in taiwan from 1990 to 2001: the impact of national health insurance. Nephrology dialysis transplantation 23, 3977-3982 (2008).
8.The diabetes control and complications trial research group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in inslin-dependent diabetes mellitus. The new england journal of medicine 130, 977-986 (1993).
9.Adler AI, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR. Development and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes Study. Kidney International 63, 225-232 (2003).
10.Gross JL, de Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelmanovitz T. Diabetic nephropathy: diagnosis,prevention, and treatment. Diabetes care 28, 164-176 (2005).
11.Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, De Zeeuw D, Hostetter TH, Lameire N, Eknoyan G. Definition and classfication of chronic kidney disease: aposition statement from kidney disease:Improving Global Outcomes(KDIGO). Kidney international 67, 2089-2100 (2005).
12.Fioretto P, Stehouwer CD, Mauer M, Chiesura-Corona M, Brocco E, Carraro A, Bortoloso E, van Hinsbergh VW, Crepaldi G, Nosadini R. Heterogeneous nature of microalbuminuria in NIDDM: studies of endothelial function and renal structure. Diabetologia 41, 233-236 (1998).
13.Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 16, 31-41 (1976).
14.Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. modification of diet in renal disease study group. Annals of internal medicine 130, 461-470 (1999).
15.Coll E, Botey A, Alvarez L, Poch E, Quintó L, Saurina A, Vera M, Piera C, Darnell A. Serum cystatin C as a new marker for noninvasive estimation of glomerular filtration rate and as a marker for early renal impairment. American journal of kidney diseases 36, 29-34 (2000).
16.Reed CH. Diagnostic applications of cystatin C. British journal of biomedical science 57, 323-329 (2000).
17.Newman DJ, Thakkar H, Edwards RG, Wilkie M, White T, Grubb AO, Price CP. Serum cystatin C measured by automated immunoassay: a more sensitive marker of changes in GFR than serum creatinine. Kidney international 47, 312-318 (1995).
18.Uchida K, Gotoh A. Measurement of cystatin C and creatinine in urine. International journal of clinical chemistry 323, 121-128 (2002).
19.Post FA, Wyatt CM, Mocroft A. Biomarkers of impaired renal function. Current opinion in HIV and AIDS 5, 524-530 (2010).
20.Norlund L, Fex G, Lanke J, Von Schenck H, Nilsson JE, Leksell H, Grubb A. Reference intervals for the glomerular filtration rate and cell-proliferation markers: serum cystatin C and serum beta 2-microglobulin/cystatin C-ratio. Scandinavian journal of clinical and laboratory investigation 57, 463-470 (1997).
21.Finney H, Newman DJ, Price CP. Adult reference ranges for serum cystatin C, creatinine and predicted creatinine clearance. Annals of clinical biochemistry 37 ( Pt 1), 49-59 (2000).
22.Kyhse-Andersen J, Schmidt C, Nordin G, Andersson B, Nilsson-Ehle P, Lindström V, Grubb A.. Serum cystatin C,determined by a rapid, automated particle-enhanced turbidimetric method, is a better marker than serum creatinine for glomerular filtration rate. Clinical chemistry 40, 1921-1926 (1994).
23.Van Pottelbergh G, Van Heden L, Matheï C, Degryse J. Methods to evaluate renal function in elderly patients: a systematic literature review. Age and ageing 39, 542-548 (2010).
24.Shankar A, Lee KE, Klein BE, Muntner P, Brazy PC, Cruickshanks KJ, Nieto FJ, Danforth LG, Schubert CR, Tsai MY, Klein R. Estimating glomerular filtration rate in a population-based study. Vascular health and risk management 6, 619-627 (2010).
25.Srivastava SK, Ramana KV, Bhatnagar A. Role of aldose reductase and oxidative damage in diabetes and the consequent potential for therapeutic options. Endocrine reviews 26, 380-392 (2005).
26.Wardle EN. Cellular oxidative processes in relation to renal disease. American journal of nephrology 25, 13-22 (2005).
27.Geraldes P, King GL. Activation of protein kinase C isoforms and its impact on diabetic complications. Circulation research 106, 1319-1331 (2010).
28.Forbes JM, Thallas V, Thomas MC, Founds HW, Burns WC, Jerums G, Cooper ME. The breakdown of preexisting advanced glycation end products is associated with reduced renal fibrosis in experimental diabetes. The FASEB journal 17, 1762-1764 (2003).
29.Feng-Chih S, Chih-Yin C, Sheng-Chi S, Rue-Tsuan L. The prevalence and risk factors of diabetic nephropathy in taiwanese type 2 diabetes.a hospital based study. Acta nephrologica 23, 90-95 (2009).
30.Nilsson-Ehle P, Grubb A. New markers for the determination of GFR: iohexol clearance and cystatin C serum concentration. Kidney international. supplement 47, S17-19 (1994).
31.Price CP, Finney H. Developments in the assessment of glomerular filtration rate.International journal of clinical chemistry 297, 55-66 (2000).
32.Sherman DS, Fish DN, Teitelbaum I. Assessing renal function in cirrhotic patients: problems and pitfalls. American journal of kidney diseases 41, 269-278 (2003).
33.Hoek FJ, Kemperman FA, Krediet RT. A comparison between cystatin C, plasma creatinine and the Cockcroft and Gault formula for the estimation of glomerular filtration rate. Nephrology dialysis transplantation 18, 2024-2031 (2003).
34.Tabaei BP, Al-Kassab AS, Ilag LL, Zawacki CM, Herman WH. Does microalbuminuria predict diabetic nephropathy? Diabetes care 24, 1560-1566 (2001).
35.Caramori ML, Fioretto P, Mauer M. The need for early predictors of diabetic nephropathy risk: is albumin excretion rate sufficient? Diabetes 49, 1399-1408 (2000).
36.Swan SK. The search continues-an ideal marker of GFR. Clinical chemistry 43, 913-914 (1997).
37.Grubb A, Simonsen O, Sturfelt G, Truedsson L, Thysell H. Serum concentr -ation of cystatin C, factor D and beta 2-microglobulin as a measure of glomerular filtration rate. Acta medica scandinavica 218, 499-503 (1985).
38.Abbink FC, Laarman CA, Braam KI, van Wijk JA, Kors WA, Bouman AA, Spreeuwenberg MD, Stoffel-Wagner B, Bökenkamp A. Beta-trace protein is not superior to cystatin C for the estimation of GFR in patients receiving corticosteroids. Clinical biochemistry 41, 299-305 (2008).
39.Grubb A, Simonsen O, Sturfelt G, Truedsson L, Thysell H. The blood serum concentration of cystatin C (gamma-trace) as a measure of the glomerular filtration rate. Scandinavian journal of clinical and laboratory investigation 45, 97-101 (1985).
40.Kazama JJ, Kutsuwada K, Ataka K, Maruyama H, Gejyo F. Serum cystatin C reliably detects renal dysfunction in patients with various renal diseases. Nephron 91, 13-20 (2002).
41.Randers E, Erlandsen EJ, Pedersen OL, Hasling C, Danielsen H. Serum cystatin C as an endogenous parameter of the renal function in patients with normal to moderately impaired kidney function. Clinical nephrology 54, 203-209 (2000).
42.Mussap M, Dalla Vestra M, Fioretto P, Saller A, Varagnolo M, Nosadini R, Plebani M. Cystatin C is a more sensitive marker than creatinine for the estimation of GFR in type 2 diabetic patients. Kidney international 61, 1453-1461 (2002).
43.Tan GD, Lewis AV, James TJ, Altmann P, Taylor RP, Levy JC. Clinical usefulness of cystatin C for the estimation of glomerular filtration rate in type 1 diabetes: reproducibility and accuracy compared with standard measures and iohexol clearance. Diabetes care 25, 2004-2009 (2002).
44.Buysschaert M, Joudi I, Wallemacq P, Hermans MP. Comparative performance of serum cystatin C versus serum creatinine in diabetic subjects. Diabetes & metabolism 29, 377-383 (2003).
45.Roos JF, Doust J, Tett SE, Kirkpatrick CM. Diagnostic accuracy of cystatin C compared to serum creatinine for the estimation of renal dysfunction in adults and children—a meta-analysis. Clinical biochemistry 40, 383-391 (2007).
46.Abrahamson M, Olafsson I, Palsdottir A, Ulvsbäck M, Lundwall A, Jensson O, Grubb A. Structure and expression of the human cystatin C gene. The biochemical journal 268, 287-294 (1990).
47.Abrahamson M, Barrett AJ, Salvesen G, Grubb A. Isolation of six cysteine proteinase inhibitors from human urine . The journal of biological chemistry 261, 11282-11289 (1986).
48.Harmoinen AP, Kouri TT, Wirta OR, Lehtimäki TJ, Rantalaiho V, Turjanmaa VM, Pasternack AI. Evaluation of plasma cystatin C as a marker for glomerular filtration rate in patients with type 2 diabetes. Clinical nephrology 52, 363-370 (1999).
49.Xia LH, Bing XG, An XT. Serum cystatin C assay for the detection of early renal impairment in diabetic patients. Journal of clinical laboratory analysis 18, 31-35 (2004).
50.Uslu S, Efe B, Alataş O, Kebapçi N, Colak O, Demirüstü C, Yörük A. Serum cystatin C and urinary enzymes as screening markers of renal dysfunction in diabetic patients. Journal of nephrology 18, 559-567 (2005).
51.Zhang PP, Zhan JF, Xie HL, Li LS, Liu ZH. Evaluation of glomerular filtration rate using cystatin C in diabetic patients analysed by multiple factors including tubular function. The journal of international medical research 38, 473-483 (2010).
52.Kiyosue A, Hirata Y, Ando J, Fujita H, Morita T, Takahashi M, Nagata D, Kohro T, Imai Y, Nagai R. Plasma cystatin C concentration reflects the severity of coronary artery disease in patients without chronic kidney disease. Circulation journal 74, 2441-2447 (2010).
53.Arpegård J, Ostergren J, de Faire U, Hansson LO, Svensson P. Cystatin C-a marker of peripheral atherosclerotic disease? Atherosclerosis 199, 397-401 (2008).
54.Koenig W, Twardella D, Brenner H, Rothenbacher D. Plasma concentrations of cystatin C in patients with coronary heart disease and risk for secondary cardiovascular events: more than simply a marker of glomerular filtration rate. Clinical chemistry 51, 321-327 (2005).
55.Eriksson P, Deguchi H, Samnegård A, Lundman P, Boquist S, Tornvall P, Ericsson CG, Bergstrand L, Hansson LO, Ye S, Hamsten A. Human evidence that the cystatin C gene is implicated in focal progression of coronary artery disease. Arteriosclerosis, thrombosis, and vascular biology 24, 551-557 (2004).
56.Jernberg T, Lindahl B, James S, Larsson A, Hansson LO, Wallentin L. Cystatin C: a novel predictor of outcome in suspected or confirmed non-ST-elevation acute coronary syndrome. Circulation 110, 2342-2348 (2004).
57.Shlipak MG, Katz R, Sarnak MJ, Fried LF, Newman AB, Stehman-Breen C, Seliger SL, Kestenbaum B, Psaty B, Tracy RP, Siscovick DS. Cystatin C and prognosis for cardiovascular and kidney outcomes in elderly persons without chronic kidney disease. Annals of internal medicine 145, 237-246 (2006).
58.Charpentier G, Riveline JP, Dardari D, Varroud-Vial M. Should postprandial hyperglycaemia in prediabetic and type 2 diabetic patients be treated? Drugs 66, 273-286 (2006).
59.Ceriello A, Davidson J, Hanefeld M, Leiter L, Monnier L, Owens D, Tajima N, Tuomilehto J; international prandial glucose regulation study group. Postprandial hyperglycaemia and cardiovascular complications of diabetes: an update. Nutrition, metabolism, and cardiovascular diseases 16, 453-456 (2006).
60.Cylwik B, Chrostek L, Jakimiuk B, Popławska A, Szmitkowski M. Serum level of sialic acid (SA) and carbohydrate-deficient transferrin (CDT) in type 2 diabetes mellitus with microvascular complications. Journal of clinical laboratory analysis 20, 68-73 (1996).
61.Snyder RW, Berns JS. Use of insulin and oral hypoglycemic medications in patients with diabetes mellitus and advanced kidney disease. Seminars in dialysis 17, 365-370 (2004).
62.Köttgen A, Selvin E, Stevens LA, Levey AS, Van Lente F, Coresh J. Serum cystatin C in the united states: the Third National Health and Nutrition Examination Survey (NHANES III). American journal of kidney diseases 51, 385-394 (2008).
63.Yokoyama H, Inoue T, Node K. Effect of insulin-unstimulated diabetic therapy with miglitol on serum cystatin C level and its clinical significance. Diabetes rearch and cinical pactice 83, 77-82 (2009).
64.Den Hollander JG, Wulkan RW, Mantel MJ, Berghout A. Correlation between severity of thyroid dysfunction and renal function. Clinical endocrinology 62, 423-427 (2005).
65.Schmitt R, Bachmann S. Impact of thyroid dysfunction on serum cystatin C. Kidney international 64, 1139-1140 (2003).


QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
無相關論文