GA及GA/HbA1c比值在诊断糖尿病肾病中的临床价值

Clinical significance of GA and GA/HbA1c ratio in the diagnosis of diabetic nephropathy

目的探讨2型糖尿病(T2DM)患者糖化清蛋白(GA)、糖化血红蛋白(HbA1c)及GA/HbA1c比值间的关系,以及其对糖尿病肾病(DN)的诊断效能。方法选取2017年1-10月该院住院T2DM患者220例,将尿清蛋白肌酐比值(UACR)>300mg/g的患者作为DN组(n=100),将UACR≤300mg/g的患者作为单纯T2DM组(n=120),比较两组一般资料、生化指标、GA、HbA1c、GA/HbA1c比值,分析各项指标间的相关性及其与DN发生的关系。采用受试者工作特征(ROC)曲线分析GA、HbA1c、GA/HbA1c对DA的诊断效能。结果 GA、GA/HbA1c比值与UACR均呈正相关(r=0.189,P=0.049;r=0.242,P=0.011)。Logistic回归分析显示,糖尿病病程、收缩压(SBP)、平均血糖、GA、GA/HbA1c比值、视网膜病变与DN相关(P<0.05)。ROC曲线下面积显示,GA/HbA1c比值(0.745)和GA(0.660)曲线下面积大于HbA1c(0.526)。结论与HbA1c相比,GA/HbA1c比值、GA水平与DN的发生、进展更为相关。

Objective To explore the relationship between glycated albumin(GA),glycosylated hemoglobin(HbA1c)and GA/HbA1c ratio in patients with type 2 diabetes mellitus(T2DM)and its diagnostic efficacy in diabetic nephropathy(DN).Methods A total of 220 cases of hospitalized patients with T2DM were selected from January to October 2017 in this hospital.According to the urinary albumin creatinine ratio(UACR),the patients were classified into 2 groups:the DN group(UACR>300 mg/g,n=100)and the simple T2DM group(UACR≤300 mg/g,n=120).The general information,biochemical indicators,GA,HbA1c and GA/HbA1c ratio were compared between the two groups,correlations were analysed between each index,and their relationships with DN were also analysed.The diagnostic efficacy of GA,HbA1c,GA/HbA1c ratio for DA was evaluated by receiver operating characteristic(ROC)curve.Results The GA and GA/HbA1c ratio were positively correlated with UACR(r=0.189,P=0.049;r=0.242,P=0.011).Logistic regression analysis showed that duration of diabetes,systolic blood pressure(SBP),mean blood glucose,GA,GA/HbA1c ratio and retinopathy were associated with DN(P<0.05).The areas under the AUC curve of GA/HbA1c ratio(0.745)and GA(0.660)were higher than that of HbA1c(0.526)for predicting DN.Conclusion Compared with HbA1c,GA/HbA1c ratio,GA level are more related to the occurrence and progression of DN.