血清 CysC、Hcy 和 U-mAlb 联合检测在早期糖尿病肾病诊断中的临床应用研究

目的：探讨血清胱抑素（Cystatin，CysC）、同型半胱氨酸（Homocysteine，Hcy）和尿微量清蛋白（Urinary mi-croalbuminuria，U-mAlb）联合检测在早期糖尿病肾病（Early diabetic nephropathy，DN）诊断中的临床应用。方法选择112例糖尿病患者，根据临床诊断将其分为 DN 尿蛋白阳性组40例（A 组）、DN 尿蛋白阴性组35例（B 组）、糖尿病无肾损害组37例（C 组），同时选择同期来医院健康体检的健康者40例作为对照（对照组），分别测定3组对象血清CysC、Hcy 和 U-mAlb 水平，并进行统计学比较。结果A 组和 B 组 CysC、Hcy 和 U-mAlb 水平明显高于 C 组和对照组（P ＜0．05），其中 A 组3项指标水平升高最为显著（P ＜0．05）。A 组和 B 组的阳性检出率明显高于 C 组和对照组（P ＜0．05），且阳性率随着患者肾损害程度的加重而升高。B 组3项指标联合检测的诊断阳性率为94．29％，明显高于各指标的单项检测（77．14％、74．29％、77．14％）（P ＜0．05）。B 组联合检测 AUC 值最高，为0．963，明显高于 Cy-sC、Hcy 和 U-mAlb 单项检测的 AUC 值（P ＜0．05）。结论联合检测 CysC、Hcy 和 U-mAlb 可以显著提高早期诊断的敏感度，有利于 DN 的早期诊断和治疗，值得临床推广应用。

The diagnostic value of CysC,Hcy and U-mAlb cinjoined detection for Early diabetic nephropathy

Objective To study diagnostic value of Cystatin （CysC）,Homocysteine （Hcy）and Urinary microalbu-minuria （U-mAlb）cinjoined detection for early diabetic nephropathy （DN）.Methods 102 cases with diabetic were choosed.According to the clinical diagnosis,they were divided into DN urine protein Positive group with 40 cases （group A）,DN urine protein negative group with 35 cases （group B）,diabetic without kidney damage group with 37 ca-ses （group C）,and 40 healthy cases as control（control group）.CysC,Hcy and U-mAlb levels in serum were measured in three groups,were statistically compared.Results CysC,Hcy and U-mAlb levels of group A and group B were sig-nificantly higher than in group C and the control group （P 〈 0.05）.And that of group A was the most significant （P 〈0.05）.The diagnostic positive rate of group A and group B were significantly higher than that of group C and the con-trol group （P 〈0.05）,and the positive rate increased with rise of the degree of renal damage in patients.The positive diagnostic rate of combined detection of group B was 94.29%,was significantly higher than 77.14%,74.29%,77.14%of single detection of each index（P 〈0.05）.The value of AUC of combined detection was 0.963,was significantly high-er than single detection （P 〈0.05）.Conclusion The combined detection of CysC,Hcy and U-mAlb significantly in-creased the diagnostic sensitivity,is worthy of clinical promotion.