联合检测血清同型半胱氨酸和尿酸对2型糖尿病肾病早期诊断的价值

目的 探讨联合检测血清同型半胱氨酸（HCY）和尿酸（UA）水平对Ⅰ型糖尿病肾病早期诊断的价值.方法 根据24h尿的尿白排泄率（UAER）,将248例2型糖尿病患者（TIDM）分为尿蛋白正常组（NA）91例,微量蛋白尿组（MA）80例和临床蛋白尿组（CP）77例.另外健康体检者70例作为对照组.分析各组血清Hcy和UA水平以及二者与糖尿病肾病间的关系.结果 糖尿病肾病各组的血清Hcy和UA水平明显高于对照组（P〈0.05）;CP组和MA组的血清Hcy和UA水平明显高于NA组（P〈0.05）.血清Hcy和UA对糖尿病肾病早期诊断的敏感性和准确性高于SCR和BUN.Spearman相关分析显示：在MA组和CP组中血清Hcy和UA水平与UAER呈高度正相关（P〈0.01）;Logistic风险回归显示：血清Hcy和UA是糖尿病肾病的重要危险因素（P〈0.05）.结论 高Hcy与高UA血症是糖尿病肾病发生发展的重要危险因素,联合监测二者对2型糖尿病肾病的早期诊断与评价具有重要临床意义.

The early diagnosis value of combinatorial determining serum homocysteine and uric acid in type 2 diabetic nephropathy

Objective To study the value of combinatorial determining serum homocysteine （Hcy） and uric acid （UA） for early diagnosis in type 2 diabetic nephropathy. Methods According to the 24h urinary albumin excretory rate （UAER）, the 248 patients with type 2 diabetes mellitus （T2DM） were classified in four groups： normoalbuminuric group （n = 91, NA）, mi- croalbuminuric group （ n = 80, MA） and clinical proteinuria group （n = 77, CP）, additional 70 people served as healthy control. Serum Hcy and UA levels were measured in all groups, and the presented study also analyzed the correlation between these two in- dices and diabetic nephropathy （DN）. Results Both Serum levels of Hcy and UA in T2DM showed significantly higher than those of healthy control （ P 〈 0.05 ） ; the levels of Hcy and UA in CP and MA were also higher than those in NA （ P 〈 0.05 ）, Hcy and UA both showed higher sensitivity and accuracy than Scr and BUN. The Spearman correlation test result found a positive corre- lation between serum Hcy and UA levels and urinary albumin excretory rate （ r = 0.69 ,P 〈 0.01 ） ; Regression Logistic analysis in- dicated that Hcy and UA were the significant risk factors for diabetic nephropathy. Conclusion The high serum levels of Hcy and UA were the important risk factors for the progression of diabetes nephropathy, combinatorial determining serum Hcy and UA had important clinical significance in diagnosing and evaluating type 2 diabetic nephropathy.