目的 探讨血清胱抑素C（Cys-C）联合β₂-微球蛋白（β₂-MG）早期诊断糖尿病肾病的应用价值。方法 选择2021年4月—2023年4月医院接收的100例糖尿病患者为对象,根据其有无合并肾脏疾病,将其分为糖尿病组及糖尿病肾病组,各50例,同比例选取同期到我院体检的健康人群50名进行对照研究,检测比较其Cys-C及β₂-MG水平,对比其Cys-C阳性率、β2-MG阳性率及联合检测阳性率,并对比不同疾病分期糖尿病肾病患者的Cys-C、β₂-MG水平。结果 糖尿病肾病患者Cys-C、β₂-MG水平高于糖尿病患者与健康者（P<0.05）。糖尿病患者Cys-C、β₂-MG水平高于健康者（P<0.05）。糖尿病肾病患者Cys-C阳性率64.00%、β₂-MG阳性率72.00%、Cys-C+β₂-MG联合检测阳性率96.00%高于糖尿病6.00%、10.00%、12.00%及健康者0.00%、0.00%、0.00%（P<0.05）;糖尿病Cys-C+β₂-MG联合检测阳性率12.00%高于健康者0.00%（P<0.05）;糖尿病肾病中Cys-C+β₂-MG联合检测阳性率96.00%高于CysC 64.00%、β₂-MG 72.00%（P<0.05）。糖尿病肾病不同分期患者Cys-C、β₂-MG水平比较,Ⅳ期>Ⅲ期>Ⅰ~Ⅱ期（P<0.05）。结论 糖尿病肾病患者Cys-C、β₂-MG水平明显升高,Cys-C、β₂-MG联合诊断更具有优势,而且肾损害越严重,Cys-C、β₂-MG异常程度越高,作为临床诊治的参考依据的价值较高。

Objective To investigate the application value of serum cystatin C（Cys-C）combined with β₂-microglobulin（β₂-MG）in the early diagnosis of diabetic nephropathy．Methods A total of 100 diabetic patients admitted to our hospital from April 2021 to April 2023 were selected as subjects,and divided into diabetes group and diabetic nephropathy group according to whether they have renal diseases or not,with 50 cases in each group．Then,50 healthy people who came to our hospital for physical examination in the same period were selected for comparative study,and their Cys-C and β₂-MG levels were detected and compared,and their Cys-C positive rate,β₂-MG positive rate and combined detection positive rate were compared．Results The levels of Cys-C and β₂-MG in patients with diabetic nephropathy were higher than those in patients with diabetes and healthy controls（P<0.05）．The levels of Cys-C and β₂-MG in diabetic patients were higher than those in healthy controls（P<0.05）．The positive rates of Cys-C（64.00%）,β₂-MG（72.00%）and Cys-C+β₂-MG（96.00%）in patients with diabetic nephropathy were higher than those in patients with diabetes（6.00%,10.00%,12.00%）and healthy subjects（0.00%,0.00%,0.00%）（P<0.05）．The positive rate of combined detection of Cys-C and β₂-MG in diabetic patients（12.00%）was higher than that in healthy subjects（0.00%）（P<0.05）．The positive rate of Cys-C combined with β₂-MG in diabetic nephropathy was 96.00%,which was higher than that of Cys-C 64.00% and β₂-MG 72.00%（P<0.05）．The levels of Cys-C and β₂-MG in patients with stage Ⅳ diabetic nephropathy were higher than those in patients with stage Ⅲ and Ⅰ-Ⅱ diabetic nephropathy（P<0.05）．The levels of Cys-C and β₂-MG in stage Ⅲ patients were higher than those in stage Ⅰ-Ⅱ patients（P<0.05）．Conclusions The levels of Cys-C and β₂-MG are significantly increased in patients with diabetic nephropathy,and the combination of Cys-C and β₂-MG has more advantages．The greater serious renal damage,the greater abnormal degree of Cys-C and β₂-MG,which has a higher value as a reference for clinical diagnosis and treatment．

目的 探讨高通量透析模式对改善维持性血液透析(MHD)患者β2微球蛋白清除率及高血压的影响。方法 选择2018年9月1日—2018年10月31日期间在广州市增城区新塘医院血液净化中心接受MHD患者40例为实验对象(除外因自身耐受因素长期使用低通量透析患者)。采用随机数表法分两组,每组20例。对照组接受低通量血液透析,观察组接受高通量血液透析。比较两组治疗效果,并记录0个月、3个月、6个月、12个月、18个月治疗前后β2微球蛋白(β2-MG)、全段甲状旁腺激素(iPTH)、心率、血压变化,并对两组心血管疾病情况进行统计。结果 观察组总有效率为95.00%,高于对照组的20.00%(P<0.05);治疗后,观察组β2-MG、iPTH均降低,而3个月后对照组略有升高,观察组[(12.48±2.10)mg/L、(210.13±18.12)ng/L]低于对照组[(30.21±2.37)mg/L、(289.41±17.02)ng/L],观察组治疗3个月、6个月、12个月、18个月的β2-MG清除率高于对照组(P<0.05);与治疗前比较,两组的平均动脉压、收缩压均降低,且观察组低于对照组(P<0.05);对照组各时间点24小时舒张压及收缩压差异无统计学意义(P>0.05);与治疗前比较,观察组24小时舒张压、收缩压治疗后1个月、3个月、6个月、12个月、18个月均降低,且低于对照组(P<0.05);两组患者心血管疾病发生率比较:观察组有1例因急性心肌梗死住院行PCI术;对照组有2例因心力衰竭住院治疗,1例因急性冠脉综合症住院治疗。两组并发症发生率比较P>0.05。结论 高通流量透析模式可有效提高MHD患者的治疗效果,有效清除血液毒素,降低患者的高血压,减少并发症,可在临床推广使用。

Objective To investigate the effect of high flux dialysis mode on the improvement of β2-microglobulin clearance and hypertension in maintenance hemodialysis (MHD) patients. Methods Patients who received MHD at the Blood Purification Center of Xintang Hospital, Zengcheng District, Guangzhou from September 1, 2018 to October 31, 2018 (except for long-term low-flux dialysis patients due to self-tolerance factors)were selected. Random number table method was used to divide the patients into two groups,20 patients in each group. The control group received low flux hemodialysis, and the observation group received high flux hemodialysis. The treatment effects of the two groups were compared, levels of β2-microglobulin (β2-MG), intact parathyroid hormone (iPTH), changes in heart rate and blood pressure, and statistics on cardiovascular disease in the two groups before and after treatment at 3, 6, 12, and 18 months were recorded. Results The total effective rate in the observation group was 95.00%, which was higher than the 20.00% in the control group (P<0.05). After treatment, the levels of β2-MG and iPTH of the two groups decreased, and the observation group [(13.02±2.10) mg/L, (210.13±18.12) ng/L] was lower than the control group [(19.78±2.37) mg/L, (289.41±17.02)ng/L]; the β2-MG clearance rate of the observation group was higher than that of the control group at 3 months, 6 months, 12 months, and 18 months (P<0.05).Compared with that before treatment, the average arterial pressure and systolic blood pressure of the two groups were reduced, and the observation group was lower than that of the control group (P<0.05); the differences between diastolic blood pressure and systolic blood pressure at each time point in the control group were not significant (P>0.05); the 24-hour diastolic blood pressure and systolic blood pressure of the observation group decreased after 1, 3, 6, 12 and 18 months, compared with those before treatment (P<0.05), and were lower than those in the control group (P＜0.05).Comparison of the incidence of cardiovascular disease between the two groups: 1 case in the observation group was hospitalized for acute myocardial infarction; 2 cases in the control group were hospitalized for heart failure and 1 case was hospitalized for acute coronary syndrome; complications incidence in the two groups were compared (P>0.05). Conclusion The high flux dialysis mode can effectively improve the treatment outcomes of MHD patients, effectively remove blood toxins, lower blood pressure, and reduce the incidence of complications. It can be used in clinical practise.