尿Ⅳ型胶原、N-乙酰-β-D-葡萄糖苷酶和血清胱抑素C、β2-微球蛋白用于糖尿病肾病辅助诊断的效能比较

Diagnosis value of urinary type Ⅳ collagen, NAG and serum CysC,β2-MG for diabetic nephropathy

目的 通过对糖尿病患者的尿Ⅳ型胶原（ⅣC）、N-乙酰-β-D-葡萄糖苷酶（NAG）、血清胱抑素C（CysC）、β2-微球蛋白（β2-MG）进行检测,比较四种指标用于糖尿病肾病（DN）早期诊断的诊断效能大小,并建立四种指标的多元回归方程.方法 收集108例糖尿病病例,参照目前糖尿病合并DN的公认诊断指标,以24 h尿微量白蛋白排泄率（UAE）=30 mg/24 h为界,把糖尿病分成2组,分别为非DN组（UAE＜30 mg/24 h）与DN组（UAE≥30 mg/24 h）,建立尿ⅣC、NAG、血清CysC、β2-MG对DN的诊断效能的受试者工作特征曲线（ROC曲线）,再根据ROC曲线下面积（AUCBOC）的大小评价四种指标在DN中的诊断效能,并以全变量回归法建立四种指标的回归方程.统计工具采用SPSS 13.0统计软件.结果 2组的尿ⅣC、NAG、血清CysC、β2-MG的检测结果非DN组分别为（3.91±1.93）μg/L、（12.20±3.46）U/L、（1.18±0.41）mg/L、（2.50±0.74）g/L;DN组分别为（14.14±11.17）μgL、（23.12±13.57）U/L、（2.69±1.69）mg/L、（5.21±2.78）g/L;非DN组与DN组的四种指标比较差异有统计学意义（P均＜0.01）.尿ⅣC、NAG、血清CysC、β2-MG的ROC曲线下面积分别为0.747、0.732、0.764、0.823,对DN的诊断效能β2-MG＞CysC＞ⅣC＞NAG,四种指标用于辅助诊断DN均有统计学意义（P均＜0.01）;尿微量白蛋白排泄率与四种指标的回归方程为UAE=-242.624＋6.362ⅣC＋8.662 NAG＋64.622 CysC＋29.488 β2-MG,方程经方差分析检验有统计学意义（P＜0.01）.结论 尿ⅣC、NAG、血清CysC、β2-MG用于辅助诊断DN均有显著性意义,可作为诊断糖尿病肾病的敏感指标.

Objective To compare the efficacy of urinary type Ⅳ collagen（ Ⅳ C）, N-acetyl-β-D-glucosaminidase（ NAG ）, serum cystatin C （ CysC ）, β2 microglobulin （ β2-MG ） in early diagnosis of diabetic nephropathy（DN） ,and to develop a multiple regression equation using above mentioned indices. Methods One hundred and eight cases of DM patients were enrolled in the study. All those DM patients were divided into two groups according to 24 hr urinary albumin excretion（UAE）： non-DN group（ UAE 〈30 mg/24 h）and DN group （UAE ≥30 mg/24 h）. Receiver operating characteristics （ROC）curve was developed using urinary IVC, NAG,serum CysC and β2-MG,and the efficiency of the four indices for early diagnosis of diabetic nephropathy were assessed by area under the curve ROC （AUCROC）. Furthermore, the regression equation of four indicators was developed. All statistical analyses were performed using SPSS 13.0. Results The levels of urine Ⅳ C, NAG,CysC,β2-MG,were（3.91±1.93）ng/ml, （ 12.20 ±3.46）U/L, （ 1.18 ±0.41 ）mg/L , （2. 50 ±0. 74）mg/ml in the non-DN group, respectively; and （ 14.14 ± 11.17 ） ng/ml, （ 23.12 ± 13.57 ） U/L, （ 2.69 ± 1.69 ） mg/L and（5.21 ± 2.78）mg/ml in the DN group, respectively. There were significant differences in the comparison of the four indicators between the two groups （ Ps 〈 0.01 ）. AUCROC of Ⅳ C, NAG, CysC and β2-MG were 0. 747,0.732,0.764 and 0.823 respectively;which meant the diagnostic efficacy for DN decended from β2-MG, CysC,Ⅳ C, to NAG in order. All these indices showed significant efficiency in assisting diagnosis of early DN （ Ps 〈0.01 ）. The regression equation of UAE and the four indices was： UAE = - 242.624 ＋ 6.362IVC ＋ 8.662NAG ＋ 64. 622CysC ＋ 29.488β2-MG, and the equation had statisticl significance（ P 〈 0.O1 ）. Conclusion Urine Ⅳ C, NAG,serum CysC, and β2-MG showed significant value in assisting diagosis of early DN, and could be sensitive indices for DN.