联合尿液标记物检测在糖尿病肾病早期诊断中的临床应用研究

目的 探讨尿微量白蛋白（mALB）、尿半胱氨酸蛋白酶抑制剂C（Cystatin C）、尿β2-微球蛋白（β2-MG）、尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）及尿视黄醇结合蛋白（RBP）在糖尿病肾病早期诊断中的临床意义.方法 选择2011年10月～ 2013年1月在本院住院的Ⅱ型糖尿病患者50例为病例组,健康体检者30例为对照组.尿mALB、Cystatin C、β2-MG及RBP采用酶联免疫吸附法检测,尿NAG采用对硝基苯酚（PNP）比色法检测,Scr由本院检验科采用OLYMPUS AU2700自动生化仪检测.并对两组检测结果进行比较及统计学分析,以受试者工作特征（ROC）曲线及曲线下面积（AUG）评价各项生物标记物的敏感性.结果 病例组中50例患者的各项指标测定含量明显高于对照组.通过ROC曲线、诊断试验结果显示：病例组中尿mALb、Cystatin C、β2-MG、RBP及NAG的敏感性显著高于血肌酐（Scr）.尿mALb、Cys-tatin C、β2-MG、RBP、NAG及Scr的曲线下面积分别为：0.976、0.976、0.929、0.917、0.882、0.710,95％的可信区间分别是0.970～1.000、0.970～1.000、0.852～0.961、0.832 ～ 0.979、0.772～0.955、0.715 ～0.806,联合以上5种尿液标记物检测的曲线下面积为0.981,95％的可信区间是0.972～1.000,差异具有统计学意义（P＜0.001）.结论 不同尿液标记物均显示了较好的敏感性,可以作为糖尿病肾病的早期诊断指标.联合多种尿液标记物检测对预防糖尿病肾病的发生、发展具有重要的临床诊断价值.

Clincal application research of combinal urinemarkers detestion in early diagnosis for diabetic nephropathy

Objectives To explore the urine trace albumin （mALB）,urine cysteine protease inhibitors （Cystatin C）,urine β2-MG microglobulin （β2-MG）,urinary n-acetyl-β-D-amino glycosidase enzymes （NAG） and urine retinol binding protein （RBP） in clinical significance for early diagnosis of diabetic nephropathy.Methods 50 cases type 2 diabetic pariets from October 2011 to January 2013 in our department in the hospital were observational group,compared with 30 health examination normal persons as control group.enzyme -linked immunosorbent method is used to detect urinary mALB,Cystatin C,β2-MG and RBP,urinary N-acetyl -β-D-glucosaminidase （NAG）levels were tested by nitro phenol （PNP） colorimetric method in these groups.Scr by our hospital clinical laboratory using push around AU2700 automatic biochemical analyzer test.And carries on the comparison to two groups of test results and statistical analysis,to the receiver-operating characteristic （ROC） curve and area under curve （AUC） in the evaluation of the sensitivity of the biomarkers.Results Cases of each index determination of content of 50 cases was obviously higher than that of control group.By ROC curve,diagnostic test results showed that cases of urinary mALb,Cystatin C,the sensitivity of the β2-MG,NAG,RBP significantly higher serum creatinine（Scr）.Urinary mALb,Cystatin C,β2-MG,RBP,NAG,and area under the curve of the Scr are：0.976,0.976,0.929,0.917,0.882,0.917,95％ CI respectively are 0.970 ～ 1.000,0.970 ～ 1.000,0.852 ～ 0.961,0.832 ～ 0.979,0.772 ～ 0.955 and 0.955 ～ 0.806,concluded five kinds of urine markers for the joint area under the curve is 0.981,95％ CI0.972 to 1.000.Statistically significant difference（P ＜ 0.001）.Conclusions Different urine markers showed good sensitivity,which can be used as an index of the early diagnosis of diabetic nephropathy.Combined the above five kinds of urine markers detection on the prevention of the occurrence and development of diabetic nephropathy have important clinical