联合检测血清胱抑素C及尿N-乙酰-β-D-葡萄糖苷酶在狼疮性肾炎诊断中的应用

Urinary inhibition C combined detection of serum and urinary n-acetyl-beta-D-glycosidase enzymes in the diagnosis of with lupus nephritis

目的探讨血清胱抑素C(cystatin C,CysC)、尿N-乙酰-β-D-葡萄糖苷酶(NAG)单项检测与联合检测在狼疮性肾炎诊断中的意义。方法选择2015年8月至2016年8月123例来我院就诊的住院及门诊的系统性红斑狼疮(SLE)患者作为实验组,50例健康体检者为对照组,分别测定血CysC、尿素氮(BUN)、肌酐(CREA)以及尿NAG的含量以及尿微量白蛋白(mALB),并记录数据。按照尿微量白蛋白的结果将实验组进一步分为3组:单纯性SLE组(23例):尿微量白蛋白<20mg/L;早期LN组(35例):尿微量白蛋白20-200mg/L;LN组(65例):尿微量白蛋白>200mg/L。分析比较结果。结果 LN组和早期LN组的Cys-C和尿NAG均高于对照组和单纯SLE组,差异有统计学意义(P<0.05),LN组的BUN和CREA均高于其他三组,差异均有统计学意义(P<0.05);而早期LN组的BUN和CREA水平与单纯SLE组比较差异无统计学意义(P>0.05)。分析提示血CysC和尿NAG在SLE的早期肾损伤的诊断中要优于BUN和CREA;采用血清CysC联合尿NAG诊断SLE伴早期肾损伤可取得最佳灵敏度(94.29%)和特异度(73.91%),优于血清CysC或尿NAG的单独检测。结论血清CysC、尿NAG的水平可作为狼疮肾炎早期诊断的可靠指标,联合检测能大大提高检测的灵敏度及特异度。

Objective Urinary inhibition to explore serum C（cystatin C,CysC）,urinary n-acetyl-beta-D-glycosidase enzymes（NAG）single detection with joint detection in the diagnosis of with lupus nephritis.Methods Choice in August 2015 to August 2016,123 cases of inpatient and outpatient of our hospital patients with systemic lupus erythematosus（SLE）as experimental group,50 cases of healthy check-up for a control,were determined CysC,blood urea nitrogen（BUN）,creatinine（CREA）,and the content of urine NAG and urine trace albumin（mALB）,and record the data.According to the urine trace albumin results from the study will be further divided into three groups：simple SLE group（23 cases）：the urine trace albumin20 mg/L;Early LN group（35 cases）,urine trace albumin 20-200 mg/L;LN group（65 cases）,urine trace albumin 200 mg/L.Analysis and comparison results.Results LN and early LN group of Cys-C and urine NAG and pure SLE group were higher than control group,the difference was statistically significant（P〈0.05）,the BUN and CREA LN group were higher than that of the other three groups,differences were statistically significant（P〈0.05）;And early level of BUN and CREA LN group there was no statistically significant difference compared with pure SLE group（P〉0.05）.Analysis of CysC blood and urine NAG in SLE in the diagnosis of early renal damage than BUN and CREA;ROC curve analysis,the use of serum CysC combined urine NAG can achieve the best sensitivity in the diagnosis of SLE with early renal damage（88.57%）and specific degrees（91.30%）,and is superior to the individual detection serum CysC or urine NAG.NAG.Conclusion The levels of serum CysC,urine NAG can be used as a reliable index in early diagnosis of lupus nephritis,joint detection can greatly improve the detection sensitivity and specific degrees.