联合检测Cys-C、NT-proBNP、DD和AT-III在糖尿病肾病早期诊断中的临床价值

The clinical value of the combined examination of the serum Cys- C,NT- pro BNP,D- Dimer and AT- III in the early diagnosis of diabetic nephropathy

目的:探讨血清胱抑素C(Cys-C)、氨基末端-脑钠肽前体(NT-pro BNP)、D-二聚体(DD)和抗凝血酶-III(ATIII)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:选取我院129例糖尿病患者,根据尿白蛋白排泄率(UAER)分为无蛋白尿组43例、微量蛋白尿组49例和临床蛋白尿组37例,另取同期健康体检者45例作为对照组。测定各组Cys-C、NT-pro BNP、DD和AT-III水平。结果:临床蛋白尿组和微量蛋白尿组各项检测水平与对照组及无蛋白尿组相比明显增高,差异有统计学意义(P<0.05);临床蛋白尿组与微量蛋白尿组各项检测水平相比差异有统计学意义(P<0.05);四者并联检测的灵敏度、特异度和诊断符合率分别为94.2%、55.8%、81.4%,灵敏度明显高于单项检测;四者串联检测的灵敏度、特异度和诊断符合率分别为40.7%、93.0%、58.1%,特异度明显高于单项检测;四项联合诊断的ROC曲线下面积(0.901)大于各指标单独诊断。结论:联合检测Cys-C、NT-pro BNP、DD和AT-III能够提高早期糖尿病肾病的诊断效果。

Objective： To investigate the clinical value of the combined examination of the serum cystatin C（ Cys- C）,N- terminal pro- Brain Natriuretic peptide（ NT- pro BNP）,D- Dimer（ DD） and antithrombin- III（ AT- III） in the early diagnosis of diabetic nephropathy. Methods： According to urinary albumin excretion rate（ UAER）,129 patients with diabetes mellitus（ DM） from our hospital were divided into the normal albuminuria group（ 43 cases）,the microalbuminuria group（ 49cases） and the macroalbuminuria group（ 37cases）. 45 healthy person without DM were selected as the control group. The serum Cys- C,NT- pro BNP,DD and AT- III were measured in each group. Results： There were significant differences when the macroalbuminuria group and the microalbuminuria group were compared separately with the control group and the normal albuminuria group in the serum level of Cys- C,NT- pro BNP,DD and AT- III（ P〈0. 05）. There were significant differences between macroalbuminuria group and microalbuminuria group in the serum level of Cys- C,NT- pro BNP,DD and AT- III（ P〈0. 05）. The detection sensitivity,specificity and diagnostic accordance rate of parallel detection were94. 2%,55. 8%,81. 4% respectively. The sensitivity of parallel detection was higher than that of the single detection. The detection sensitivity,specificity and diagnostic accordance rate of tandem detection were 40. 7%,93. 0%,58. 1% respectively. The specificity of tandem detection was higher than that of the single detection. ROC areas（ 0. 901） of combined examination were larger than those of each indicator. Conclusions： The combined examination of the serum Cys- C,NT- pro BNP,D- Dimer and AT- III could improve the effect of early diabetic nephropathy.