血清CysC、Hcy、hs-CRP和U-mAlb联合检测对糖尿病早期肾损害的临床价值研究

Study the clinical values of serum CysC,Hcy,hs-CRP and U-mAlb in diabetes patients with early renal damage

目的探讨糖尿病(DM)患者血清中胱抑素C(CysC)、同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)和尿微量清蛋白(U-mAlb)水平的联合检测对糖尿病肾病(DN)早期诊断的临床价值。方法采用免疫透射比浊法和比色法分别检测126例2型糖尿病(T2DM)患者(观察组)及80例健康体检者(对照组)血清CysC、Hcy、hs-CRP和U-mAlb含量,并对检测结果进行统计学分析。结果观察组血清CysC、Hcy、hs-CRP和U-mAlb水平均明显高于对照组,差异有统计学意义(P<0.01);CysC、Hcy、hs-CRP和U-mAlb单项指标检测对DM早期肾损害的阳性检出率分别为60.32%、75.40%、84.13%、63.49%,特异性为95%～100%,与对照组比较,差异有统计学意义(P<0.001);4项指标联合检测,敏感性可提高至96.83%,且敏感性和特异性之和最大。血清CysC与Hcy、hs-CRP和U-mAlb水平均呈显著正相关(r=0.952、0.971、0.926,P<0.01)。结论血清CysC、Hcy、hs-CRP和U-mAlb可作为DN早期诊断的敏感指标,联合检测更具实用价值。

Objective To investigate the diagnostic value of combined detection of serum cystatin C （CysC）, homocysteine （Hcy）,high sensitivity C-reactive protein （hs-CRP）and urine micro-albumin （U-mAlb） in type-2 diabetic mellitus （T2DM） patients with early diabetic nephropathy. Methods 126 T2DM patients and 80 normal subjects were studied. Nephelometry and the colorimetry were respectively used to test for the levels of serum CysC ,Hcy,hs-CRP and morning U-mAlb. Results The levels of serum CysC,Hcy,hs-CRP and U-mAlb in patients with T2DM were significantly higher than those in control group （P0.01）. The sensitivity of detection of serum CysC,Hcy,hs-CRP and U-mAlb were 60.32%, 75.40%, 84.13% and 63.49%, respectively. The specificity was 95～100%. The positive rate in patients with T2DM was significantly higher than the control （P0.001）. Combined determination of serum CysC,Hcy,hs-CRP and U- mAlb would increase the sensitivity to 96.83%. There was a positive correlation in the increase of CysC , Hcy, hs-CRP and U-mAlb （r=0.952、0.971、0.926,P0.01）. Conclusion The levels of serum CysC,Hcy,hs-CRP and U-mAlb may all be used as sensitive indicators for the diagnosis of early diabetic nephropathy in T2DM patients.