血清视黄醇结合蛋白和胱抑素C在2型糖尿病早期肾功能损害中的应用

Application value of serum retinol binding protein and cystatin C on early renal damage of type 2 diabetic nephropathy

目的应用受试者特征工作曲线(ROC曲线)评价血清视黄醇结合蛋白(RBP)和胱抑素C(Cys C)在2型糖尿病(T2DM)早期肾功能损害中的临床价值。方法选择2013年7月至2014年5月泸州医学院附属医院门诊或住院部确诊的T2DM患者155例为研究对象,根据尿微量清蛋白/尿肌酐比值将患者分为单纯糖尿病(SDM)组、早期糖尿病肾病(EDN)组和临床糖尿病肾病(CDN)组;另选同一时期健康体检者为健康对照组。采用胶体金增强免疫法和免疫比浊法分别检测RBP和Cys C,通过ROC曲线评价其对糖尿病早期肾功能损害的价值。结果随着病情进展血清RBP、Cys C水平逐渐增高,EDN组Cys C、RBP水平与健康对照组、SDM组对比,差异均有统计学意义(P<0.05),且与尿微量清蛋白/肌酐有较好相关性。血清RBP、Cys C的ROC曲线下面积分别为0.770、0.868,最佳截点值分别为40.95mmol/L、1.055mmol/L,灵敏性和特异性分别为81.0%、93.7%和95.2%、78.1%。结论 RBP和Cys C是检测早期肾功能损害的良好标志物,Cys C的诊断效果优于RBP,联合检测可提高早期糖尿病肾功能损害的诊断效率。

Objective To evaluate the diagnostic value of the serum retinol binding protein （RBP） and cystatin C （Cys C）on the early stage of type 2 diabetic nephropathy by roc curve .Methods According to the ratio of urinary albumin and urinary creatinine ,155 patients with type 2 diabetes were divided into simple diabetic mellitus （SDM ） group ,early stageof diabeticnephropathy（EDN）group ,andclinicalstageof diabeticnephropathy（CDN）group ,while healthy persons were recruited randomly at the same period as control group .The level of serum RBP and Cys C were detected by colloidal gold immunoenhancement method and immunoturbidimetry .The diagnostic value of RBP and Cys C in the early stage of type 2 diabetic nephropathy was analyzed by ROC curve .Results With the development of the disease ,the level of serum RBP and Cys C increased ,RBP and Cys C in CDN group were significant higher than those in the SDM group and the NC group（P〈0 .01） ,while had a correlation with the rario of urinary albumin and creatinine .The area under the ROC curve of RBP and Cys C in serum were 0 .770 ,0 .868;the cutoff value were 40 .95 mmol/L ,1 .055 mmol/L ;the sensitivity were 81 .0% ,93 .7% ;the specificity were 95 .2% ,78 .1% .Conclusion RBP and Cys C were good markers in detecting early renal damage ,the diagnostic value of Cys C was superior to RBP ,and combined detection of the two methods will greatly improve the efficiency of diagnosing for early diabetic kidney inju-ry .