3项指标联合检测在2型糖尿病早期肾损害的诊断价值

Diagnostic value of combined measurement of serum Hcy,serum Cys C,urinary microalbumin and urinary creatinine ratio levels in type 2 diabetes mellitus with early kidney injury

目的探讨联合检测同型半胱氨酸(Hcy)、血清胱抑素C(Cys C)和尿微量清蛋白(UmAlb)与尿肌酐(UCr)比值在2型糖尿病(T2DM)肾损害早期诊断和治疗意义。方法依据24h尿微量白蛋白的定量测结果将182例T2DM患者分为3组:A组为糖尿病无肾病组(UmAlb<30mg/24h)60例,B组为早期糖尿病肾病组(EDN)(UmAlb≧30mg～300mg/24h)62例,C组为糖尿病明显肾病组(ADN)(UmAlb>300mg/24h)60例。对这3组患者进行血清Cys C、Hcy、UmAlb/UCr、血肌酐(SCr)、血尿素氮(BUN)含量检测,并与50例健康对照组进行比较。结果 B组CysC、Hcy、UmAlb/UCr水平分别为(1.95±0.52)mg/L、(17.18±2.57)μmol/L、(142.5±31.47)mg/g,C组分别为(2.43±0.65)mg/L、(19.28±3.66)μmol/L、(387.2±61.48)mg/g,均高于健康对照组和A组,差异有统计学意义(P<0.05);C组血清Cys C、血清Hcy、UmAlb/UCr水平高于B组,差异有统计学意义(P<0.05);以单一指标阳性作为诊断标准,血清Cys C、血清Hcy、UmAlb/UCr对2型糖尿病肾损害的阳性率分别为85.2%、80.3%、86.9%,3项联合检测阳性率达96.7%,明显高于单项检测(P<0.05)。结论联合检测血清Hcy、血清Cys C、UmAlb/UCr对2型糖尿病肾病早期诊断及病情监测具有重要价值。

Objective To explore the diagnostic value of combined measurement of serum homocysteine （Hcy）,serum cystatin C（Cys C）, urinary microalbumin（UmAlb） and urinary creatinine（UCr） ratio levels in type 2 diabetes mellitus with early kidney injury. Methods 182 cases of type 2 diabetes mellitus（T2DM）patients were en- rolled and divided into three groups according to the excretion rate 24 hour urinary microalbumin. A group without diabetic nephropathy（UmAlb^30 mg/24 h）（NDN,60cases）, g group with early diabetes nephropathy（30 rag/24 h UmAlb ≤ 300 mg/24 h （EDN, 62 cases）, C group with apparent diabetic nephropathy （UmAlb 〉300 mg/24 h （ADN,60 cases）, and 50 healthy people served as normal control group（D group）. Serum Cys C, Serum homocysteine, urinary microalbumin, urinary creatinine, serum creatinine and blood urea nitrogen of these four groups were de- tected simultaneously. Results Levels of serum Hcy, serum Cys C, UmAlb/UCr ratio in these two groups（B, C group）were higher than D group, Serum Hey, serum Cys C, UmAlb/UCr ratio were significantly different between group B, C and group D（P〈0.05）. Levels of serum H cy, serum Cys C, UmAlb/UCr ratio in these two groups（B, C） were higher than A group. Serum Hcy, serum Cys C, UmAlb/UCr ratio were significantly different between group B, C and group A（P〈0.05）. Levels of serum Hcy,serum Cys C,UmAlb/UCr ratio in the group C were higher than group B. Serum Hcy,serum Cys C,UmAlb/UCr ratio were significantly different between group C and group B（P〈 0.05）. As a single positive marker for diagnosis, the sensitivity for serum CysC, serum Hcy, and UmAlb/UCr were 85.2%, 80.3 % and 86.9% respectively, the positive rate of combined detection was 96.7%, which was significantly higher than that of the individual testing（P〈0.05）. Conclusion Combined measurement of serum Hcy,serum Cys C,and UmAIb/UCr ratio levels has important clinical value for diagnosis and condition monitoring in type 2 diabetes mellitus with early kidney injury.