ROC曲线评价多参数对2型糖尿病早期肾损伤的预警作用

Evaluation of ROC curve on prewarning role of multi-parameter to early renal damage in T2DM

目的探讨多个实验室指标对于2型糖尿病(T2DM)早期肾损伤(DN)诊断的作用,并分析其联合应用的价值。方法检测病程5年以上的T2DM尿蛋白定性阴性患者(TD组)血浆胱抑素C(CYS-C)、尿微量清蛋白(MAU)、尿β2微球蛋白(β2-MG)、尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、尿α1微球蛋白(α1-MG)水平,并以健康者作为对照(NC组),比较两组受试者上述指标的水平,用ROC曲线评价这些指标对于T2DM早期肾损伤诊断的临床应用价值。结果 TD组各指标水平均高于NC组,差异有统计学意义(P<0.05);由ROC曲线可知,各指标对T2DM患者并发早期肾损伤诊断价值由高到低依次为CYS-C、α1-MG、MAU、NAG、β2-MG,曲线下面积分别为0.984、0.982、0.980、0.969、0.858。结论以上指标均可以用于T2DM早期肾损伤的预警,但灵敏度与特异度均较高的是CYS-C、α1-MG和MAU。

Objective To evaluate the role of multiple laboratory indexes for diagnosing early renal damage in type 2 diabetes mellitus（T2DM ） and to analyze their combined application value .Methods The T2DM patients with over 5 years and negative urine protein negative were selected as the TD group and detected serum CYS‐C ,urine MAU ,β2‐MG ,NAG and α1‐MG .The healthy individuals were taken as the control group .The levels of above indexes were compared between the two groups .The clinical application values of these indexes for diagnosing early renal damage were evaluated by the ROC curves .Results The indexes levels in the TD group were higher than those in the control group ,the differences were statistically significant .The ROC curves indicated that the diagnostic values of the various indexes for T2DM complicating early renal damage were in turn CYS‐C ,α1‐MG ,MAU ,NAG and β2‐MG ,and the areas under curves（AUC） were 0 .984 ,0 .982 ,0 .980 ,0 .969 and 0 .858 respectively .Conclusion The above inde‐xes all can be used as the prewarning of early renal damage in T2DM ,but CYS‐C ,α1‐MG and MAU have higher sen‐sitivity and specificity .