五项诊断指标联合检测对糖尿病肾病患者应用的价值

Value of five diagnostic indicators in combined detection for diagnosis of diabetic nephropathy

目的:研究糖尿病肾病(DN)患者血清同型半胱氨酸(HCY)、胱抑素C(Cys-C)、α1-微球蛋白(α1-MG)、可溶性血栓调节蛋白(sTM)及C反应蛋白(CRP)等5项诊断指标的变化及其诊断价值。方法:将292例糖尿病患者(DM组)分为单纯性糖尿病组(SDM组)95例,早期糖尿病肾病组(EDN组)98例,临床糖尿病肾病组(CDN组)99例,与健康对照组(102例)平行检测上述5项指标。结果:DM组各项指标水平明显高于健康对照组(P<0.01)。糖尿病肾病组(DN)血清5项指标水平组间存在显著差异(P<0.01)。并且随着DN病情进展,各项指标随着24 h尿蛋白排泄率(UAER)的增加逐渐增高(P<0.01),且互相之间关系密切,表明其升高与DN的发生、发展密切相关。在DM患者的病情发展过程中,HCY、Cys-C、α1-MG、STM、CRP最早出现,可为疾病的早期诊断提供数据。结论:血清HCY、CYS-C、α1-MG水平可作为DN早期肾损伤的反应肾小球滤过功能的敏感指标;STM反映高HCY水平的DN患者的微血管损伤程度;CRP与DN患者病情正相关,可作为DN患者病情检测新指标,5项联合检测可提高检出敏感性及阳性率,全面协助DN肾损伤的早期诊断。

Objective：To investigate the change in levels of serum hemocysteine （HCY） ,cystatin-C （CYS- C） ,α1-microglobulin （α1-MG） , soluble thrombomodulin （sTM） and C reactive protein （CRP） and their diagnostic values in diabetic nephropathy （DN）. Methods：292 DN patients were divided into simple DN group （ SDN group, n = 95 ）, early DN （ EDN group, n = 98 ）, clinical DN （ CDN group, n = 99 ） to undergo parallel detections of the five indicators. The results were compared with those of 102 healthy subjects （ healthy control group）. Results： DN group had significantly higher levels of all indicators as compared with the control group, which reached the level of significant difference （ P 〈 0.01 ）. There was a remarkable inter-group difference in the serum levels of five indicators in DN group （P 〈 0. 01 ）. As DN progressed, the five indicators gradually increased along with 24-hour urinary albumin excretion rate （UAER） （ P 〈 0.01 ） and closely correlated with one another,suggesting that the elevations of five indicators were closely associated with occurrence and development of DN. In the progression of DM, HCY, Cys-C,（xl-iG, sTM and CRP were earliest indicators that can provide information for early diagnosis. Conclusion： 1 ） The levels of serum HCY, CYS-C, α1-MG could be considered as the sensitive indicators to reflect glomerular filtration in early kidney injury in DN. 2 ） sTM could reflect the degree of microvascular injury in patients with high HCY level. 3 ） CRP, positively correlated with the conditions of DN patients, could be used as a novel indicator in detecting DN conditions. Combined detection of the five diagnostic indicators might increase sensitivity and positive rate of and provide overall assistance to the early diagnosis of DN kidney injury.