五项生化指标联合检测在早期糖尿病肾病中的诊断价值分析

Diagnostic value of combined detection of five biochemical indexes in early diabetic nephropathy

目的探讨血清胱抑素C(cystatin C,Cys-C)、同型半胱氨酸(homocysteine,Hcy)、超敏C-反应蛋白(hypersensitive C-reactive protein,hs-CRP)、尿β2微球蛋白(urineβ2microglobulin,U-β2MG)及尿微量白蛋白(urinary albumin,UAlb)联合检测在早期糖尿病肾病(diabetic nephropathy,DN)中的诊断价值。方法选取2012年1月至2016年5月新沂市中医医院收治的48例早期DN患者为观察组,按1:1比例抽取同期住院的48例糖尿病(diabetes mellitus,DM)不合并DN患者为对照组,对照组48例患者肾小球滤过率正常,彩超检查肾脏形态、大小正常。两组患者均于入院后24 h内分别抽取空腹肘静脉血3 ml,离心后检测血清Cys-C、Hcy、hs-CRP、U-β2MG及UAlb,Cys-C及U-β2MG检测均采用免疫透射比浊法,Hcy检测采用酶法,hs-CRP及UAlb检测均采用免疫散射比浊法,均按说明书进行操作。结果 2组入院后血清Cys-C[(1.16±0.24)mg/L vs(0.93±0.20)mg/L,t=5.161]、hs-CRP[(7.1±2.9)mg/L vs(4.4±2.7)mg/L,t=4.730]、Hcy[(22.20±3.95)mg/L vs(15.26±3.55)mg/L,t=9.047]、U-β2MG[(0.526±0.110)mg/L vs(0.407±0.136)mg/L,t=4.700]及UAlb[(42.8±6.5)mg/L vs(10.4±3.2)mg/L,t=31.022]水平对比,观察组明显高于对照组,差异均有统计学意义(P<0.01)。观察组血清Cys-C、hs-CRP、Hcy、U-β2MG及UAlb检测阳性率分别为84.3%、78.6%、78.5%、89.2%及91.2%,联合检测阳性率为100%,联合检测明显提高了检测的阳性率。结论血清Cys-C、Hcy、hs-CRP、U-β2MG及UAlb是反映DM患者早期肾功能损伤敏感、准确、简便、可靠的指标,可以早期诊断DN,值得临床推广应用。

Objective To investigate the diagnostic value of combined detection of serum cystatin C（ Cys-C）,homocysteine（ Hcy）,hypersensitive C-reactive protein（ hs-CRP）,urine β2 microglobulin（ U-β2 MG） and urinary albumin（ UAlb） in early diabetic nephropathy（ DN）. Methods From January 2012 to May 2016,48 cases of early DN admitted to our hospital were selected as the observation group,and according to the proportion of 1∶ 1,48 cases of diabetes mellitus（ DM） without DN served as control group. In control group,glomerular filtration rate was normal,and color ultrasound examination displayed normal kidney morphology and size. Within 24 h after admission,3 ml fasting venous blood was taken out for detection of serum Cys-C,Hcy,hs-CRP,U-β2 MG and UAlb after centrifugation. U-β2 MG and Cys-C were detected by immune turbidimetry,Hcy by enzymatic method,and hs-CRP and UAlb by immune scattering turbidity method according to the instructions. Results After admission,serum Cys-C [（ 1. 16 ± 0. 24） vs.（ 0. 93 ±0. 20） mg/L,t = 5. 161],hs-CRP [（ 7. 1 ± 2. 9） vs.（ 4. 4 ± 2. 7） mg/L,t = 4. 730 ],Hcy [（ 22. 20 ±3. 95） vs.（ 15. 26 ± 3. 55） mg/L,t = 9. 047],U-β2 MG [（ 0. 526 ± 0. 110） vs.（ 0. 407 ± 0. 136） mg/L,t = 4. 700] and UAlb [（ 42. 8 ± 6. 5） vs.（ 10. 4 ± 3. 2） mg/L,t = 31. 022] in the observation group were significantly higher than those in the control group（ P〈0. 01 for all）. The positive rates of serum Cys-C,hs-CRP,Hcy,U-β2 MG and UAlb in the observation group were 84. 3%,78. 6%,78. 5%,89. 2% and 91. 2%,respectively. The positive rate of combined detection was 100%,and the positive rate was improved by combined detection. Conclusions The serum Cys-C,hs-CRP,Hcy,U-β2 MG and UAlb are sensitive,accurate,simple and reliable indicators of early renal function damage in DM patients. It can be used in early diagnosis of DN,and it is worthy of clinical popularization and application.