血清胱抑素C和尿α_1-微球蛋白联合检测对多发性骨髓瘤肾功能损害的早期诊断价值

The Value of Combined Detection of Serum Cystatin C and Urine α_1-Microglobulin in the Early Diagnosis of Renal Dysfunction with Multiple Myeloma

目的探讨血清胱抑素C(CysC)和尿α_1-微球蛋白(α_1-MG)联合诊断对多发性骨髓瘤(MM)肾功能损害的早期诊断价值。方法选取2015年1月至2017年12月收治的MM患者130例作为MM组,根据血清肌酐值(176.8μmol/L将MM患者分为肾功能正常组、肾功能损害组,选取同期入院体检的健康志愿者60例作为对照组,检测血清CysC、尿α_1-MG水平,通过ROC曲线明确预测截点,并分析血清CysC、尿α_1-MG及两者联合诊断MM肾功能损害的效能。结果MM组血清CysC、尿α_1-MG水平高于对照组,MM肾功能正常组血清CysC、尿α_1-MG水平低于肾功能损害组,差异有统计学意义(P<0.05);以血肌酐> 176. 8μmol/L作为诊断MM肾功能损害的切点,绘制血清CssC、尿α_1-MG诊断MM肾功能损害的ROC曲线,血清CysC、尿α_1-MG的预测截点分别为0. 86mg/L、4.18mg/L,血清CysC检测MM肾功能损害的AUC、灵敏度、特异性分别为0. 788、77.59%、77.78%,尿α_1-MG分别为0. 821、81. 03%、81.94%,联合诊断分别为0.901、91. 38%、88.89%,三者比较差异有统计学意义(P<0.05)。结论血清Cysc、尿α_1-MG联合诊断对MM肾功能损害早期诊断的灵敏度、特异性高于单一指标检测。

Objective To explore the value of combined detection of serum cystatin C(CysC)and urine α1-microglobulin(α1-MG)in the early diagnosis of renal dysfunction with multiple myeloma(MM).Methods 130 patients with MM treated from January 2015 to December 2017 were selected as MM group.According to the serum creatinine value(176.8μmol/L),patients were divided into the normal renal function group and renal dysfunction group.60 healthy volunteers who received physical examination during the same period of time were selected as the control group.Levels of serum Cysc and urine α1-MG was detected for both groups.The best point of diagnosis was determined by ROC curve.The diagnostic efficiencies of serum Cysc,urine α1-MG and the combination of the two were then analyzed.Results Levels of serum Cysc,and urine α1-MG were higher in MM group than in control group,and higher in renal dysfunction group than in normal renal function group(P<0.05).With serum creatinine level>176.8 mol/L as the cutoff point for diagnosis of MM,the ROC curves of serum CysC and urine α1-MG for the diagnosis of MM nephropathy were drawn.The predictive cutoff points of serum CysC and urine α1-MG were 0.86mg/L and 4.18mg/L,respectively.The AUC,sensitivity and specificity of serum CysC in the diagnosis of MM with renal function damage were 0.788,77.59%and 77.78%,respectively,those of urineα1-MG were 0.821,81.03%and 81.94%,respectively,and those of combined detection were 0.901,91.38%and 88.89%,respectively(P<0.05).Conclusion The sensitivity and specificity of the combined detection of serum Cysc and urineα1-MG in the early diagnosis of renal dysfunction in MM are higher than those of single detection.