多项检测指标在2 型糖尿病早期肾损伤中的诊断价值

目的 分析尿白蛋白/ 肌酐比值(ACR)、尿α1-微球蛋白(α1-MG)、尿β2-微球蛋白(β2-MG)和血清胱抑素C(CysC)在2 型糖尿病早期肾损害中的诊断价值。方法 选取2019 年5 月至2020 年1 月芜湖市中医医院收治的2 型糖尿病患者108 例,根据尿蛋白排出率(UAER)将患者分为单纯糖尿病组(UAER <30 mg/ 24 h)68 例和糖尿病肾病组(30 mg/ 24 h≤UAER<300 mg/ 24 h)40 例。并选取同期健康体检者30 例为健康对照组。观察各组尿ACR、尿α1-MG、尿β2-MG 和血清CysC 水平并进行统计学比较。绘制受试者工作特征(ROC)曲线预测各指标对早期糖尿病肾损伤的曲线下面积(AUC),并计算各指标的敏感度和特异度。结果 糖尿病肾病组和单纯糖尿病组的尿ACR、尿α1-MG、尿β2-MG 和血清CysC 水平明显高于健康对照组(P 均<0. 05)。糖尿病肾病组的尿ACR、尿α1-MG、尿β2-MG 和血清CysC 水平明显高于单纯糖尿病组(P 均<0. 05)。尿ACR、尿α1-MG、尿β2-MG 和血清CysC的曲线下面积分别为0. 923、0. 851、0. 755 和0. 702,敏感度分别为84. 4%、75. 0%、71. 9%和62. 5%,特异度分别为96. 4%、85. 5%、81. 8%和67. 3%。结论 尿ACR、尿α1-MG、尿β2-MG 和血清CysC 在糖尿病早期肾损伤的进程中有着重要的作用,其测定有助于糖尿病肾病的早期诊断,为临床诊治提供可靠的依据。

Diagnostic value of multiple indexes in patients of type 2 diabetes mellitus with early renal injury

Objective To assess the diagnostic value of urine albumin / creatinine ratio(ACR), urine α1-microglobulin (α1-MG), urine β2-microglobulin (β2-MG) and serum cystatin C (CysC) level in patients of type 2 diabetes mellitus(T2DM) with early renal injury. Methods Totally, 108 patients with T2DM admitted to and treated in our hospital were included from May 2019 to January 2020, and divided into simple T2DM group(n =68, UAER <30 mg / 24h) and diabetic nephropathy group(n = 40, 30 mg / 24 h≤UAER <300 mg / 24 h) according to urinary albumin excretion rate (UAER). Another 30 healthy volunteers undergoing physical examination in the corresponding period were recruited as controls. The levels of urinary ACR, α1-MG, β2-MG and serum CysC were maintained and statistically analyzed. Receiver-operating characteristic(ROC) curve was mapped for evaluating the sensitivity and specificity of urinary ACR, α1-MG, β2-MG and serum CysC level in predicting early renal injury of diabetics by the area under curve (AUC). Results Patients in simple T2DM group and diabetic nephropathy group had higher level of urinary ACR, α1-MG, β2-MG and serum CysC than those of healthy controls(all P<0. 05). The urinary ACR,α1-MG, β2-MG and serum CysC levels were significantly higher in diabetic nephropathy group than in simple T2DM group(all P<0. 05). The AUC was 0. 923, 0. 851, 0. 755 and 0. 702, respectively for urinary ACR, α1-MG, β2-MG and serum CysC, and the sensitivity and specificity were 84. 4% , 75. 0% , 71. 9% and 62. 5% ; and 96. 4% , 85. 5% , 81. 8% and 67. 3% , respectively, for the four indicators described above. Conclusion Urinary ACR, α1-MG, β2-MG and serum CysC levels are important roles in earlyrenal injury in patients of diabetes mellitus. Measurement of the four indicators can be conductive to early diagnosis of diabetic nephropathy as well as reliable evidence for clinical estimation of such condition.