HbA1c、尿AAG和血清CysC对早期糖尿病肾病的诊断价值

Diagnostic value of HbA1c,urinary AAG and serum Cys C for early diabetic nephropathy

目的探讨糖化血红蛋白(HbA1c)、尿α_1-酸性糖蛋白(AAG)和血清半胱氨酸蛋白酶抑制剂C(CysC)3项指标单项及联合检测对早期糖尿病肾病(DN)的诊断价值。方法纳入同期入院诊治的2型糖尿病患者158例,根据尿微量清蛋白/肌酐比值(ACR)水平分为无肾病的单纯糖尿病组111例和早期DN组47例;选取健康志愿者45例为健康人对照组;检测研究对象HbA1c、尿AAG和血清CysC并进行统计学分析。绘制ROC曲线并计算曲线下面积(AUC),评价各指标的诊断价值。结果早期DN组HbA1c、尿AAG和血清CysC检测结果均高于单纯糖尿病组和健康人对照组,差异均有统计学意义(P均<0.05)。HbA1c、尿AAG和血清CysC任意两者之间均呈正相关(P均<0.01)。HbA1c、尿AAG和血清CysC3项联合检测诊断早期DN的AUC为0.986,高于各指标单项检测时的AUC(分别为0.818、0.897和0.932)。结论HbA1c、尿AAG和血清CysC均是评价早期DN的有效指标;3项联合检测有助于提高诊断效能。

Objective To explore the diagnostic value of the single examination of hemoglobin A1 c （ HbA1 c）, urinary αl-acid glyco- protein（ AAG）, serum cystatin C（CysC） and the combined examination of the 3 indices for early diabetic nephropathy（DN）. Meth- ods A total of 158 cases of type 2 diabetic patients were recruited in this study. Based on urine albumirdcreatinine（ACR） levels, the patients were divided into two groups： non-DN group 111 cases and early DN group 47 eases. Forty-five cases of healthy subjects（ NC group） were recruited as control group. The levels of HhAlc, urinary AAG and serum CysC of all the subjects were measured. By u- sing logistic regression, ROC curve was plotted and the area under ROC curve（AUC） was calculated to assess the diagnostic value of each index. Results The levels of HbAlc, urinary AAG and serum CysC in early DN group was significantly higher than those in non-DN group and NC group, and the differences were statistically significant（ P 〈 0.05 ）. Positive correlations were found between any two of HbAlc, urinary AAG and serum CysC（P 〈 0.01 ）. The AUC of the combined examination of HbAlc, urinary AAG and serum CysC for early DN was 0. 986, which was higher than the AUC（0. 818, 0. 897, 0. 932） of single examination of HbAlc, urinary AAG or serum CysC, respectively. Conclusion All the 3 indices, urinary AAG, serum CysC and HbAlc, should be available for the diag- nosis of early DN. The combined examination may improve diagnostic performance.