Hcy、hsCRP、Lpa、尿NAG对糖尿病肾病早期诊断的临床意义

目的探讨血清同型半胱氨酸(Hcy)、超敏C反应蛋白(hsCRP)、脂蛋白a(Lpa)、尿N-乙酰-β-D氨基葡萄糖苷酶(uNAG)对糖尿病肾病(DN)诊断的临床意义。方法根据24 h白蛋白排泄率(UAER),将194名糖尿病患者和60名正常体检者分为糖尿病正常蛋白尿组(DM)、早期糖尿病肾病组(DN1)、临床糖尿病肾病组(DN2)和正常对照组,检测四组患者Hcy、Lpa、hsCRP、uNAG水平。结果随着病情进展,Hcy、hsCRP、Lpa、uNAG水平逐渐升高,糖尿病各组间比较有显著性差异;Hcy、hsCRP、Lpa、uNAG分别与UAER呈正相关(r=0.606,0.676,0.612,0.842;P<0.05);Hcy、hsCRP、Lpa、uNAG的AUC曲线下面积(AUCROC)分别为0.691、0.734、0.707、0.909,以上四项联合检测AU-CROC为0.962,比单个检测准确性更高。结论 Hcy、Lpa、hsCRP、uNAG能作为早期DN诊断的指标。

Clinical significance of serum Hcy, hsCRP, Lpa and urine NAG in the diag- nosis of early diabetic nephropathy

Objective To investigate the clinical significance of serum homocysteine （Hcy）, high sensitivity C-reactive pro- tein （hsCRP）, lipoproterin a （Lpa）, urine N-acetyl-D-glucosaminidase （uNAG） in the diagnosis of diabetic nephropathy. Methods According to 24 hours albumin excretion rate （UAER）, 194 patients with diabetic mellitus and 60 normal subjects were divided into four groups, including diabetes mellitus without albuminuria （DM）, early diabetic nephropathy （DN1）, clinical diabetic nephropathy （DN2） and normal subjects. Serum Hey, Lpa, hsCRP and uNAG of all subjects were measured. Results The levels of Hcy, hsCRP, Lpa and uNAG in every group of DM increased along with the aggravation of the dis- ease, and were significant difference; Hey, hsCRP, Lpa and uNAG was significantly correlated with UAER respectively （r = 0.606, 0.676, 0.612, 0.842; P 〈 0.05）; The area under the receive-operator characteristic curve （AUCROC） of Hey, hsCRP, Lpa, uNAG were 0.691, 0.734, 0.707, 0.909. The combined detection of them was more powerful （AUCROC 0.962） for diag- nosis of diabetic nephropathy, superior to that for single detection. Conclusion Hcy, Lpa, hsCRP, uNAG could be used to as sensitive indicator for the diagnosis of early diabetic nephropathy.