多指标联合检测在糖尿病肾病早期诊断中的临床应用

Clinical value of combined detection of multiple markers in early diagnosis of diabetic nephropathy

目的探讨血清胱抑素C(Cys C)、同型半胱氨酸(Hcy)、β2-微球蛋白(β2-MG)及尿微量白蛋白(mA lb)联合检测在糖尿病肾病(DN)早期诊断中的临床应用价值。方法选取264例2型糖尿病(T2DM)患者为研究对象,分为两个观察组,即132例糖尿病肾病患者为DN组,132例单纯糖尿病患者为T2DM组;另选取132例同期健康体检者为对照组。在贝克曼库尔特AU680型全自动生化分析仪上采用乳胶增强免疫散射比浊法测定血清中的Cys C、β2-MG及尿液mA lb水平;罗氏Cobas E411型全自动电化学发光免疫分析仪上采用酶动力学法测定血清Hcy水平。对比分析各组指标的检测结果。结果与对照组比较,DN组和T2DM组的Cys C、Hcy、β2-MG、mA lb四项观察指标的检测结果均明显增高(P<0.01),且DN组的四项指标检测结果增高更明显(P<0.01);相关性分析结果显示,Cys C与Hcy呈正相关(r=0.663,P<0.05),Cys C、Hcy与mA lb均呈负相关(r=-0.712、-0.632,P均<0.05),而Cys C、Hcy、mA lb均与β2-MG相关不显著;ROC曲线分析结果也显示,Cys C、Hcy、β2-MG及mA lb的ROC曲线下面积分别为0.815、0.916、0.807和0.783,标准误(sx珋)分别为0.050、0.023、0.045和0.018,95%置信区间分别为0.736~0.893、0.875~0.965、0.733~0.885和0.712~0.865;四项指标(Cys C+Hcy+β2-MG+mA lb)联合检测的阳性率为96.21%(127/132),三项指标(Cys C+Hcy+β2-MG)联合检测的阳性率为90.15%(119/132),两项指标(Cys C+Hcy)联合检测的阳性率为84.10%(119/132),均明显高于单项指标(Cys C)检测的阳性率71.96%(95/132)。结论定期监测血清Cys C、Hcy、β2-MG及尿液mA lb等多项指标变化,有助于了解糖尿病肾病患者的病情发展,其临床应用价值优于单项观察指标,值得推广应用。

Objective To investigate the clinical value of combined detection of serum cystatin C（Cys C）,homocysteine（Hcy）,β2-microglobulin （β2-MG） and microalbuminuria（mAlb） in early diagnosis of diabetic nephropathy（DN）.Methods 264 cases of type 2 diabetes mellitus（T2DM） patients were selected as research objects and divided into two observation groups,that was,132 DN patients were selected as DN group,and 132 patients with simple diabetes mellitus as T2DM group.And another 132 healthy subjects were selected as control group.And then,serum levels of Cys C,β2-MG and mAlb were determined by latex enhanced immune scattering turbidimetry on Beckman Kurt AU680 automatic biochemical analyzer.Serum level of Hcy was measured by enzyme kinetic method on Roche Cobas E411 automatic electrochemiluminescence immunoassay analyzer.Test results of each index were compared and analyzed among all groups.Results Compared with the control group,detection results of Cys C,Hcy,β2-MG,mAlb of the DN group and T2DM group all significantly increased（P〈0.01）,and the detection results of the four indexes of the DN group increased more significantly（P〈0.01）.Correlation analysis showed that the Cys C was positively correlated with Hcy（r=0.663,P〈0.05）,Cys C,Hcy and mAlb were negatively correlated（r=-0.712,-0.632,all P〈0.05）,while Cys C,Hcy,mAlb were all not significantly correlated with β2-MG.ROC curve analysis results also showed that area under the ROC curve of Cys C,Hcy,β2-MG and mAlb were 0.815,0.916,0.807 and 0.783,respectively,standard errors（s（x）） was 0.050,0.023,0.045 and 0.018,respectively,95% confidence intervals was 0.736~0.893,0.875~0.965,0.733~0.885 and 0.712~0.865,respectively.The positive rate of combined detection of the four indicators （Cys C＋Hcy＋β2-MG＋mAlb） was 96.21%（127/132）,that of combined detection of the three indicators （Cys C＋Hcy＋β2-MG） was 90.15%（119/132）,and that of combined detection of the two indicators （Cys C＋Hcy） was 84.10%（119/132）,all significantly higher than that 71.96%（95/132） of single index （Cys C）.Conclusion Regular monitoring for changes of indexes like Cys C,Hcy,β2-MG and urine mAlb can help to understand the development of diabetic nephropathy patients,and its clinical value is better than that of single observation index.Thus, it is worthy of popularization and application.