糖尿病肾病早期诊断指标的前瞻性筛选研究

The prospective screening research on early diagnosis index of diabetic nephropathy

目的探讨在现有的检验项目中筛选糖尿病肾病早期诊断的敏感指标。方法采用前瞻性研究的方法,在糖尿病患者(该院2012年2月至2013年2月治疗的已确诊的300例Ⅱ型糖尿病患者)治疗队列中进行糖尿病早期肾损伤的检验指标筛选研究,使用全自动生化分析仪检测临床各项指标,观察早于24h尿清蛋白(UAE)出现异常的检验指标,并选取同期100例健康体检者进行对比分析。结果筛选出由血胱抑素C(Cys C)、视黄醇结合蛋白(RBP)以及尿中Cys C、RBP组成联合检测的方法,作为糖尿病肾病早期诊断的敏感指标,随着病患肾损害程度的加重,糖尿病肾病患者血Cys C、RBP以及尿中Cys C、RBP检测均呈现递增趋势,与入组时相比差异均有统计学意义(P<0.01);以UAE水平的异常(>30mg/24h)为金标准,联合血Cys C、RBP以及尿中Cys C、RBP检测,其阳性率可达100%,上述4项指标联合检测可以预测早期糖尿病肾病,敏感性优于UAE,能够提前半年筛查出50%早期肾损伤的糖尿病患者。结论同时检测血中CysC和RBP以及尿中CysC和RBP可反映糖尿病早期肾损伤的不同部位,对于诊断早期糖尿病肾病以及干预治疗具有很高的临床价值。

Objective To select a sensitive index for the early diagnosis of diabetic nephropathy during the current inspection i-tems .Methods With the prospective researching method ,the screening research on laboratory test parameters of early renal injury of diabetes was conducted among the 300 diagnosed Ⅱ type diabetics who were seeking for therapy in our hospital from February , 2012 to February ,2013 .We used the automatic biochemical analyzer to test every clinical index .And we observed the abnormal la-boratory test parameters that arose prior to the 24 h uric albumin .Then we selected 100 healthy controls of the same period for con-trastive analysis .Results We selected a test method composed of Serum Cys C ,Serum RBP ,Uric Cys C and Uric RBP .It was se-lected as the sensitive index for the early diagnosis of diabetic nephropathy .We found that the heavier renal injury became ,the high-er detection value composed of Serum Cys C ,Serum RBP ,Uric Cys C and Uric RBP appeared .Compared with the initial data ,the test index showed a very significant difference （P〈 0 .01） .And with the golden standard of abnormal content of UAE （〉 30 mg/24 h） as well as the test method composed of Serum Cys C ,Serum RBP ,Uric Cys C and Uric RBP ,the positive rate of testing result could be 100 percent .So we found that the four testing indexes can be used to predict the early diabetic nephropathy jointly .Their sensibility can be superior to that of UAE .They can help to discover 50 percent of diabetics who were suffering from early renal in-jury in half a year ahead .Conclusion To inspect the value of Serum Cys C ,Serum RBP ,Uric Cys C and Uric RBP can be helpful for diabetics to find out different parts of early renal injury .Consequently ,this test method is quite valuable for the diagnosis and therapy of early diabetic nephropathy .