糖尿病早期肾损害尿液不同诊断指标检测意义

Significance of different diagnostic indexes of early kidney injury in diabetic patients

目的探讨不同尿液指标在糖尿病早期肾损害预测中的临床价值。方法 2型糖尿病患者30例(观察组),体检健康者60例为对照组,2组采用ELISA法检测尿转铁蛋白、尿微量白蛋白、尿半胱氨酸蛋白酶抑制剂C、尿视黄醇结合蛋白及尿β2-微球蛋白,采用对硝基苯酚比色法检测N-乙酰-β-D-氨基葡萄糖苷酶水平,采用ROC曲线评价各项检测指标诊断糖尿病早期肾损害的价值。结果观察组尿转铁蛋白、尿微量白蛋白、尿半胱氨酸蛋白酶抑制剂C、尿视黄醇结合蛋白、尿β2-微球蛋白、尿N-乙酰-β-D-氨基葡萄糖苷酶及血清肌酐水平及阳性率均明显高于对照组(P<0.05);尿转铁蛋白、尿微量白蛋白、尿半胱氨酸蛋白酶抑制剂C、尿β2-微球蛋白、尿视黄醇结合蛋白、尿N-乙酰-β-D-氨基葡萄糖苷酶及血清肌酐诊断糖尿病早期肾损害的AUC分别为1.000、0.985、0.985、0.942、0.921、0.891、0.785。结论不同尿液指标均显示较好的敏感性,联合应用多种尿液指标可较好预测糖尿病早期肾损害的发生,对预防糖尿病肾病的发展有重要临床价值。

Objective To explore the clinical value of different urine indexes in the diagnosis of early kidney injury in diabetic patients. Methods The levels of urinary transferrin （TRF）, micro-albumin （mAlb）, eystatin C （CysC）, retinol binding protein （RBP） and ]32 micro-globulin （132 MG） were detected by using ELISA technique, and the urinary N-acetyl- β-D-glucosaminidase （NAG） level was detected by using nitrophenol colorimetrie method in 30 cases of type 2 diabetes mellitus （observational group） and 60 health volunteers （control group）. The value of different urine indexes to diagnosing early kidney injury was assessed by ROC curve in diabetic patients. Results The levels of urinary TRF, mAlb, CysC, RBP, 132-MG, NAG and serum creatinine （SCr） as well as their positive rates were higher in observation group than those in control group （P〈0.05）. The AUC of urinary TRF, mAlb, CysC, RBP, β2-MG, NAG and SCr to diagnose early kidney injury were 1. 000, 0. 985, 0. 985, 0. 942, 0. 921, 0. 891 and 0. 785, respectively. Conclusion All above urinary indexes have high sensitivity. The combination detection of various urinary indexes may predict early kidney injury in diabetic patients, which play an important role in preventing the progress of diabetic nephropathy.