生物标志物联合检测在早期糖尿病肾病诊断中的应用

目的探讨血清肌酐(SCr)、血尿素(Sur)、血清胱抑素C(CysC)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)及C1q联合检测用于早期糖尿病肾病辅助诊断的临床价值。方法回顾性分析十堰市太和医院2018年收治的单纯糖尿病患者50例、早期糖尿病肾病患者65例及健康体检者150例的临床资料,均行SCr、Sur、CysC、NGAL及C1q检测,计算以上指标单项和联合检测用于早期糖尿病肾病的诊断效能,并采用单因素方差分析比较组间差异。结果早期糖尿病肾病患者男性比例、年龄、Sur水平、SCr水平、CysC水平、尿微量清蛋白与尿肌酐比值(UACR)、C1q水平及NGAL水平均明显高于单纯糖尿病患者和健康体检者,差异均有统计学意义(P<0.05);早期糖尿病肾病患者肾小球滤过率明显低于单纯糖尿病患者和健康体检者,差异均有统计学意义(P<0.05)。相关指标单项检测时,CysC诊断效能最高,Sur最低,其中CysC诊断效能明显高于C1q、NGAL、SCr及Sur,差异均有统计学意义(P<0.05)。相关指标2项联合检测时,C1q+CysC诊断效能最高,SCr+NGAL最低,C1q+CysC诊断效能均明显高于其他组合,差异均有统计学意义(P<0.05);而CysC+NGAL、SCr+C1q及C1q+NGAL明显高于SCr+NGAL、SCr+CysC,差异均有统计学意义(P<0.05)。相关指标3项联合检测时,C1q+CysC+NGAL诊断效能最高,SCr+NGAL+CysC最低;C1q+CysC+NGAL、C1q+CysC+SCr及SCr+C1q+NGAL诊断效能明显高于SCr+NGAL+CysC,差异均有统计学意义(P<0.05)。C1q+NGAL+CysC+SCr检测较其他组合诊断效能均高,但C1q+NGAL+CysC+SCr、C1q+CysC+NGAL、SCr+C1q+CysC及CysC+C1q的诊断效能组间比较差异均无统计学意义(P>0.05),且CysC+C1q诊断特异度较C1q+NGAL+CysC+SCr更高。结论 C1q、CysC及NGAL用于早期糖尿病肾病的辅助诊断价值优于SCr、Sur,且C1q联合CysC检测应用诊断效能更佳。

Application of combined detection of biomarkers in diagnosis of early diabetic nephropathy

Objective To investigate clinical value of combined detection of serum creatinine(Scr),serum urea(Sur),Cystatin C(CysC),neutrophil gelatinase-associated lipocalin(NGAL)and C1q in patients with early diabetic nephropathy.Methods The clinical data of 50 patients with simple diabetes mellitus,65 patients with early diabetic nephropathy and 150 health peoples were retrospectively analyzed in 2018 in Taihe Hospital of Shiyan and the levels of Scr,Sur,CysC,NGAL and C1q of all cases were tested.The diagnostic performance of above indicatores for early diabetic nephropathy was calculated by single and combined tests,and the differences between groups were compared by one-way ANOVA.Results The male proportion,age,the levels of Sur,Scr,CysC,urinary microalbumin to creatinine(UACR),C1q and NGAL of patients with early diabetic nephropathy were significant higher than patients with simple diabetes mellitus and health peoples(P<0.05).The levels of glomerular filtration rate(eGFR)of patients with early diabetic nephropathy were significant lower than patients with simple diabetes mellitus and health peoples(P<0.05).The highest and lowest diagnostic performances were CysC and Sur when the related indicators were detected separately.The diagnostic efficiency of CysC were significantly higher than C1q,NGAL and Scr(P<0.05).The highest and lowest diagnostic performances were separately C1q+CysC and Scr+NGAL when the related indicators were combined detection for two kinds of laboratory biomarkers.The diagnostic efficiency of C1q+CysC were significantly higher than other kinds(P<0.05).The diagnostic efficiency of CysC+NGAL,Scr+C1q and C1q+NGAL were significantly higher than Scr+NGAL and Scr+CysC(P<0.05).The highest and lowest diagnostic performances were separately C1q+CysC+NGA and Scr+NGAL+CysC when the related indicators were combined detection for three kinds of laboratory biomarkers.The diagnostic efficiency of C1q+CysC+NGAL,C1q+CysC+Scr and Scr+C1q+NGAL were significantly higher than Scr+NGAL+CysC(P<0.05).The combined detection of C1 q+NGAL+CysC+Scr had the highest diagnostic performance than other types.There was no significant difference in the diagnostic performance among C1q+NGAL+CysC+Scr,C1 q+CysC+NGAL,Scr+C1q+CysC and CysC+C1q(P>0.05).The diagnostic specificity of CysC+C1q was higher than that of C1q+NGAL+CysC+Scr.Conclusion The diagnostic value of C1 q,CysC and NGAL in early diabetic nephropathy are better than that of Scr and Sur,and combined detection of C1q and CysC possess was the better diagnostic performance.