血浆CysC、Hcy、sICAM-1对糖尿病肾病早期检测的临床价值

Clinical value of plasma Cys C,Hcy,sICAM-1 for early detection of diabetic nephropathy

目的：研究同型半胱氨酸（homocysteine,Hcy）、胱抑素C（cystatin C,CysC）、可溶性细胞间粘附分子-1（soluble intercellular adhesion molecule-1,s ICAM-1）在2型糖尿病及糖尿病肾病（diabetic nephropathy,DN）患者血浆中的水平变化,探讨联合检测敏感性对DN早期的意义。方法：以尿微量白蛋白肌酐比值（urinary albumin creatinine ratio,UACR）为DN诊断标准,将180例2型糖尿病受试者分为糖尿病非肾病组（NDN组）和糖尿病肾病（DN组）,以90例正常人作为对照组（NC组）,比较3组间Hcy、CysC、s ICAM-1水平的差异,以及与UACR的关系。以NDN组、DN组作ROC曲线,计算三者单独检测及联合检测的敏感性及特异性。结果：①DN组Hcy、CysC、s ICAM-1和UACR水平均高于NC组,差异有统计学意义（P值均为0.000）,且高于NDN组（P值均为0.000）;NDN组Hcy、CysC水平高于NC组（P值均为0.000）,s ICAM-1在两组间未见统计学差异（P=0.153）;②DN组Hcy、CysC、s ICAM-1敏感性分别为81.11%、56.7%、10%,特异度分别为47.7%、77.8%、97.7%,联合检测敏感性为88.8%,各指标ROC曲线下面积分别为0.74、0.78、0.72,95%CI分别为0.667-0.816、0.707-0.843、0.640-0.794,P值均为0.000,联合检测ROC曲线下面积为0.813,95%CI=0.748-0.878;③Hcy、CysC、s ICAM-1水平与UACR呈正相关（r值分别为0.028、0.449、0.164,P值分别为0.001、0.000、0.047）。结论：DN早期Hcy、CysC、s ICAM-1已异常升高,且与UACR呈正相关关系,三者联合检测可提高DN早期检出率。

Objective：To explore the significance of combined detection of cystatin C（CysC）,homocysteine（Hcy）,soluble intercellular adhesion molecule-1（s ICAM-1）in the early detection of diabetic nephropathy（DN）. Methods：According to urinary albumin creatinine ratio（UACR）,180 diabetic cases were divided into non-diabetic nephropathy group（NDN） and diabetic nephropathy group（DN）,and 90 normal persons were taken as the control（NC）. The levels of Hcy,CysC,s ICAM-1 in the three groups were detected,and their relationship with UACR was observed. The ROC curve was drawn and its sensitivity and specificity was calculated. Results：（1）Hcy,CysC,s ICAM-1 and UACR levels were higher in group DN than in group NC and group NDN,with statistically significant differences（P1=0.000,P2=0.000,P3=0.000,P4=0.000）. Hcy and CysC levels were higher in group NDN than in group NC（P1=0.000,P2=0.000,P3=0.000,P4=0.000）,and there was no statistical difference in s ICAM-1 between the two groups（P=0.153）.（2）In group DN,the sensitivity rates of Hcy,CysC,s ICAM-1 were 81.11%,56.7%,10% respectively;the specificity rates were 47.7%,77.8%,97.7%,38.89%,97.7%;the area under the ROC curve of each index were 0.74,0.78,0.72（P1=0.000,P2=0.000,P3=0.000）;95%CI were0.667-0.816,0.707-0.843,0.640-0.794 respectively. For joint detection,the sensitivity was 88.8%,the area under the ROC curve was 0.813,95% CI was 0.748-0.878.（3）Hcy,CysC,s ICAM-1 was positively correlated with UACR（r were 0.028,0.449,0.164 respectively,P1=0.001,P2=0.000,P3=0.047）. Conclusion：Hcy,CysC,s ICAM-1 can be detected at early stage of diabetic nephropathy,and are positively correlated with UACR. Combined detection of the three can improve the early detection rate of DN.