尿轻链、尿微量清蛋白和尿α1-微量球蛋白联合检测在糖尿病早期肾损害中的临床意义

Clinical significance of joint detection of urine light chains,urine microalbumin and urine α1-microglobulin in early diabetic kidney injury

目的探讨尿轻链、尿微量清蛋白(mALB)和尿α1-微量球蛋白(α1-MG)联合检测在糖尿病早期肾损害中的临床价值。方法选择2型糖尿病患者218例和健康体检者62例分别作为观察组和对照组,采用速率散射比浊法检测两组尿κ轻链、尿λ轻链、尿mALB和尿α1-MG水平,并对检测结果进行比较分析。结果观察组尿κ轻链、尿λ轻链、尿mALB和尿α1-MG阳性率明显高于对照组,差异有统计学意义(P<0.01);观察组κ/λ值与对照组比较,差异无统计学意义(P>0.05)。受试者工作特征曲线分析显示:尿κ轻链、尿λ轻链、尿mALB和尿α1-MG的曲线下面积及95%CI分别为0.763、0.541、0.854、0.807和0.708~0.817、0.464~0.691、0.811~0.897、0.758~0.856;4项尿液指标联合应用后曲线下面积及95%CI为0.919和0.886~0.951,差异有统计学意义(P<0.01)。结论尿κ轻链、尿λ轻链、尿mALB和尿α1-MG联合检测对预测糖尿病早期肾损害的发生发展有重要临床价值。

Objective To explore the clinical value of joint detection of urine light chains,urine microalbumin and urineα1-microglobulin in early diabetic kidney injury.Methods 218 cases type 2 diabetes mellitus（T2 DM）were selected as the observational group and 62 cases undergoing healthy physical examination as the control group.The rate scattering turbidimetry method was adopted to detect urinaryκlight chains,urinaryλlight chains,urinary micro-albumin（mALB）,α1-microglobulin（α1-MG）in the two groups.Then the test results were performed the comparative analysis.Results The positive rate of urineκlight chains,urineλlight chains,mALB andα1-MG in the observational group were significantly higher than those in the control group,the difference was statistically significant（P0.01）;theκ/λvalue had no statistical difference between the observation group and control group（P0.05）.The receiver-operating characteristic curve analysis showed that the area under curve（AUC）of urineκlight chains,urineλlight chains,mALB andα1-MG,and 95%CI were 0.763,0.541,0.854,0.807 and 0.708-0.817,0.464-0.691,0.811-0.897 and 0.758-0.856 respectively,AUC and 95%CI of joint detection of 4 urine indicators were 0.919 and 0.886-0.951,the difference was statistically significant（P0.01）.Conclusion The combined detection of urineκlight chains,urineλlight chains,mALB andα1-MG has an important clinical value for predicting early diabetic kidney injury.