钠尿肽系列在2型糖尿病肾病中的变化及意义

Clinical Value of Natriuretic Peptide in Type 2 Diabetic Nephropathy

目的探讨钠尿肽系列对2型糖尿病早期肾损伤筛选的价值。方法采用放免法检测正常对照组(37例)、2型糖尿病无肾病组(31例)、2型糖尿病早期糖尿病肾病组(26例)和2型糖尿病明显肾病组(23例)的C型利钠肽(CNP)与尿钠素(URO),分析各组间水平的变化,并进行钠尿肽系列与尿微量白蛋白与尿肌酐比值(MA/UCr)的相关分析。诊断性能采用受试者工作特征(ROC)曲线进行分析。结果在2型糖尿病无肾病组、早期肾病组和明显肾病组间,随着肾损伤程度的加深,患者CNP与URO的浓度出现显著性的减低(P<0.001);而无肾病组CNP显著高于对照组(P<0.001)。钠尿肽系列与MA/UCr间相关性分析显示:存在良好的负相关关系(P<0.001)。而且在2型糖尿病早期阶段,CNP与URO在ROC曲线的线下面积为0.762和0.759,取临界值≤10.2 pg/mL和≤51.5 pg/mL时,其敏感性与特异性分别为:69.34%和70.23%、67.14%和71.29%,与MA/UCr有相近的诊断效率。结论 CNP与URO作为2型糖尿病早期肾损伤的筛查指标是有一定临床价值的。

Objective To investigate the clinical value of natriuretic peptide in tubular injury of type 2 diabetes mellitus.Methods 37 healthy controls,31 type 2 diabetics without nephropathy,26 patients with pristine diabetic nephropathy and 23 patients with clinical diabetic nephropathy were enrolled in the study and categorized into four groups.C-type natriuretic peptide （CNP） and urodilatin （URO） were measured by radioimmunoassay.The changes of CNP and URO levels among four groups were analyzed,and correlation analyses were performed between natriuretic peptide and urinary micro-albumin/urine creatinine （MA/UCr）.The efficiency index of CNP and URO were evaluated by receiver operation characteristic （ROC）.Results Compared with those in the diabetics without nephropathy,pristine diabetic nephropathy and clinical diabetic nephropathy,the CNP and URO levels decreased significantly in the course of diabetic nephropathy （P ＜0.001）.The levels CNP were significantly increased in the diabetics without nephropathy compared to controls （P ＜0.001）.The value of CNP and URO were significantly correlated with MA/UCr （P ＜0.001）.In early phase of type 2 diabetes mellitus,the area under curve of CNP and URO were 0.762 and 0.759.When the cut-off values of CNP and URO were ≤ 10.2 pg/mL and ≤ 51.5 pg/mL,The sensitivity and specificity were 69.34％ and 70.23％,67.14％ and 71.29％,respectively.Furthermore,CNP and URO had similar diagnosis efficiency with MA/UCr.Conclusion The changes of CNP and URO level have clinical value in pristine tubular injury of type 2 diabetes mellitus.