糖尿病向糖尿病肾病转化时血清标记物水平的临床价值

Clinical Value of Biomarkers in Patients with DM Transferring to DN

目的探讨糖尿病（DM）向糖尿病肾病（DN）转化时相关检测指标的临床价值。方法155例DM患者根据24h尿蛋白排泄率（UAER）分成三组，其中单纯DM（SDM）组57例、早期DN（EDN）组46例、临床DN（CDN）组52例。循环酶法测定155例DM患者和60名正常对照组（NC）组UAER、BUN、Cr；电化学发光法测定HCY、D．D、CA19．9、T3。结果SDM组、EDN组、CDN组患者随微血管病变的严重程度尿UAER和血清HCY、D—D和CA19-9水平增高；T3的水平降低；BUN、Cr差异均无统计学意义（P〉0．05）。HCY、D．D、CA19-9和T3的ROC曲线下面积（AUC）分别为0．9324、0．7618、0．7423和0．8152％；诊断截值分别为19．67μmol／L、516．37ng／mL、33．49U／mL和1．53nmol／L；敏感度分别为93．68％、76．22％、75．84％和80．36％；特异度分别为95．87％、79．47％、76．31％和82．25％。结论血清HCY、D．D、CA19．9和T3是DM向DN转化时的有价值诊断指标，以血清HCY较好。

Objective To explore clinical value of biomarkers in patients with DM transferring to DN. Methods The serum HCY, D-D, CA19-9 and T3 levels were determined in 52 cases CDN, 46 cases EDN, 57 cases SDM and 60 NC by electrochemiluminescence immunoassay etc. with compared study. Results The serum BUN and Cr levels in 52 cases CDN, 46 cases EDN, 57 cases SDM had no significant difference compared with those in 60 NC （P all 〉 0.05）. UAER levels in patients with DM increased with severity. In biomarkers, the serum HCY, D-D and T3 levels in 52 cases CDN, 46 cases EDN, 57 cases SDM were significantly higher than those in 60 NC, and increased with severity. The serum T3 levels was significantly lower than those in 60 NC and was decreased with severity. ROC curve showed that the AUC of serum HCY, D-D, CA19-9 and T3 were 0.9324, 0.7618, 0.7423 and 0.8152 respectively; the best cut-offvalue were 19.67 Ix mol/L, 516.37 ng/mL, 33.49 U/mL and 1.53 nmol/L respectively; the sensitivity were 93.68%, 76.22%, 75.84% and 80.36%, respectively; the specificity were 95.87%, 79.47%, 76.31% and 82.25%. Conclusion The serum HCY, D-D, CA19-9 and T3 levels are valuable indexes of early diagnosis and in patients with DM transferring to DN.