血清NGAL和Cys C联合检测在诊断2型糖尿病早期肾损伤中的价值

目的探讨血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)与胱抑素C(Cys C)联合检测在诊断2型糖尿病早期肾损伤中的作用。方法选取2型糖尿病患者95例,根据24 h尿蛋白排泄率(UAER)分为正常白蛋白尿(NA)组(29例,UAER<30 mg/24 h)、微量白蛋白尿(MA)组(33例,UAER为30~<300mg/24h)和临床白蛋白尿(CA)组(33例,UAER>300mg/24h)。以78名体检健康者作为正常对照组。检测所有对象的血清尿素、肌酐(Cr)、尿酸(UA)、NGAL、Cys C水平及尿α₁-微球蛋白(α₁-MG)水平,采用受试者工作特征(ROC)曲线评价各项指标诊断2型糖尿病早期肾损伤的价值。结果MA组和CA组血清尿素、Cr、UA、NGAL、CysC水平及尿α₁-MG水平均高于NA组和正常对照组(P<0.05)。MA组与CA组之间、NA组与正常对照组之间各项指标差异均无统计学意义(P>0.05)。ROC曲线分析结果显示,血清尿素、Cr、UA、NGAL、Cys C及尿α₁-MG单项检测诊断2型糖尿病早期肾损伤的曲线下面积(AUC)分别为0.649、0.713、0.632、0.795、0.869和0.660,NGAL与Cys C联合检测诊断2型糖尿病早期肾损伤的AUC为0.881。NGAL与Cys C联合检测的AUC高于各项指标单项检测的AUC(P<0.0001)。结论血清NGAL和Cys C在2型糖尿病早期肾损伤的诊断中有重要价值,是理想的筛查指标。

Combined detection of serum NGAL and Cys C in the diagnosis of early nephropathy in patients with type 2 diabetes mellitus

Objective To investigate the role of combined detection of neutrophil gelatinase-associated lipocalin(NGAL)and cystatin C(Cys C)in early renal injury in patients with type 2 diabetes mellitus(T2DM).Methods A total of 95 T2DM patients were enrolled in the study.According to 24-hour urinary albumin excretion rate(UAER),there were 29 patients with normal urinary albumin(NA group,UAER<30 mg/24 h),33 patients with microalbuminuria(MA group,UAER:30-300 mg/24 h)and 33 patients with clinical albuminuria(CA group,UAER>300 mg/24 h).Seventy-eight healthy subjects were collected into control group.The levels of serum urea,creatine,uric acid,NGAL,Cys C and urineα1-microglobulin were measured.The receiver operating characteristic(ROC)curve were applied for the evaluation of the diagnostic value of the indices.Results The levels of serum urea,creatine,uric acid,NGAL,Cys C and urineα1-microglobulin in MA and CA groups were significantly higher than those in the NA and control groups(P<0.05).However,no significant difference was found in these indices between the NA and control group,or between the MA and CA group(P>0.05).ROC curve showed that the area under curve(AUC)of serum urea,creatine,uric acid,NGAL,Cys C and urineα1-microglobulin were 0.649,0.713,0.632,0.795,0.869 and 0.660,respectively.The joint detection of NGAL and Cys C had a higher AUC value(0.881)than the above-mentioned single index(P<0.0001).Conclusions The combined detection of NGAL and Cys C can facilitate the diagnosis for early renal injury in T2DM patients and serve as an ideal index of screening.