三项指标联合检测在糖尿病肾病早期诊断中的临床价值

Clinical value of the combined detection of three indicators for early diagnosis of diabetic nephropathy

目的:探讨血清视黄醇结合蛋白4(RBP4)、胱抑素C(CysC)和同型半胱氨酸(Hcy)联合检测在糖尿病肾病(diabetic nephropathy,DN)早期诊断中的临床价值。方法:将确诊的98例2型糖尿病患者根据尿液白蛋白排泄率分为:正常白蛋白组(A组)、微量白蛋白组(B组)和大量白蛋白组(C组),同时以30例健康体检者作为对照组(NC组)。检测血清RBP4、CysC、Hcy、尿素氮(BUN)、肌酐(Cr)水平,并对结果进行统计学处理。结果:血清RBP4、Hcy、CysC水平A、B、C组高于NC组,B、C组高于A组,差异均有统计学意义(P<0.05)。血清BUN、Cr水平A组、B组与NC组比较差异无统计学意义(P>0.05)。B组联合检测的ROC曲线下面积(AUC)为0.952,有较高的准确性;RBP4、Hcy、CysC的AUC分别为0.850、0.824、0.817;BUN、Cr的AUC分别为0.643、0.633。结论:血清RBP4、Hcy、CysC是DN早期诊断的敏感指标,联合检测能提高DN早期诊断的准确性。

Objective： To explore the clinical value of the combined detection of retinol binding protein 4 （RBP4）, cystatin C （CysC） and homocysteine （Hcy） for early diagnosis of diabetic nephropathy （DN）.Methods：98 diagnosed patients with type 2 diabetes were divided into 3 groups according to the excretion rate of urine albumin： normal albumin group （group A）, trace albumin group （group B） and mass albumin group （group C）, at the same time, 30 healthy subjects were taken as the nephropathy control group （NC group）. The levels of serum RBP4, CysC, Hcy, blood urea nitrogen （BUN） and creatinine （Cr） were detected, and the results were statistically processed.Results： The serum RBP4, CysC and Hcy in group A, B and C were higher than those of NC group, and those of the group B and C were higher than those of group A, with statistically signiifcant differences. There was no statistically signiifcant difference of serum BUN and Cr level between group A, group B and NC group. ROC-AUC of combined detection in group B was 0.952, showing a higher accuracy. AUCs of RBP4, Hcy and CysC were 0.850, 0.824 and 0.817, while AUCs of BUN and Cr were 0.643 and 0.633.Conclusion： The serum RBP4, Hcy and CysC are sensitive indicators for early diagnosis of DN. And the combined detection can improve the accuracy in early diagnosis of DN.