血清胱抑素C、C反应蛋白和尿β2-微球蛋白联合检测在2型糖尿病肾病诊断中的价值

Combined examination of serum cystatin C, C reactive protein, and β-2 urine microglobulin for diagnosing type 2 diabetic nephropathy

目的 探讨血清胱抑素C （Cys C）、C反应蛋白（CRP）及尿β 2微球蛋白（β 2-MG）联合检测在2型糖尿病肾病（diabetic nephropathy,DN）诊断中的临床应用价值.方法 选择我院111例2型糖尿病患者为研究对象,根据患者尿白蛋白排泄率（UAER）分为三组：B组为正常蛋白尿组42例（UAER＜20μg/min）,C组为微量蛋白尿组33例（20μg/min≤UAER≤200μg/min）,D组为大量蛋白尿组36例（UAER＞200μg/min）;同时选择40例健康者作为对照组（A组）.测定各组血CysC、CRP和尿β 2-MG,应用Pearson＇s相关性分析检测各指标与UAER的关系,受试者工作特征（ROC）曲线测试各指标及联合检测检效能.结果 DN患者Cys C、CRP和尿β 2-MG明显高于对照组（P＜0.05）;糖尿病患者Cys C、CRP和尿β 2-MG水平与UAER呈显著正相关（r分别为0.65、0.46、0.53,P＜0.05）;CysC、CRP和尿β 2-MG联合诊断的ROC曲线下面积大于各指标单独诊断.结论 糖尿病患者血CysC、CRP和尿β 2-MG水平的升高与其早期肾损伤的发生密切相关,联合应用可以提高DN早期肾损伤诊断的准确性.

Objective To investigate the clinical value of the combined examination of serum Cystatin C （Cys C）,C reactive protein （CRP）,and β-2 urine microglobulin （β 2-MG） in the diagnosis of type 2 diabetic nephropathy （DN）.Methods 141 patients with diabetes mellitus （DM） from our hospital were divided into 3 groups according to urinary albumin excretion rate （UAER）：42 cases in group B （UAER ＜ 20 μg/min）,33 cases in group C （20 μ g/min ≤ UAER ≤ 200 μ g/min）,and 36 cases in group D （UAER ＞ 200 tμ g/min）.40 health persons without DM were seslected a control group （group A）.The serum Cys C,CRP,and urine β 2-MG concentrations were measured in each group.The relationship between UAER and each indicator was evaluated by pearson＇ s correlation analysis,and the efficiencies of each indicator and combination examination were evaluated by ceiver operating characteristic （ROC） curve analysis.Results The Cys C,CRP,and β 2-MG concentrations were statistically higher in the DN patients than in the control group （P ＜ 0.05） and were higher in group C and D than in group B （P ＜ 0.05）.In DM patients,Cys C,CRP,and β 2-MG positively correlated with UAER （r =0.65,0.46,0.53,respectively,P ＜ 0.05）.ROC areas of combined examination were larger than that of each indicator.Conclusions Cys C,CRP,and β 2-MG are sensitive indicators for early diagnosing DN.Combined examination can improve the accuracy of the early diagnosis of DN.