尿液RBP和ALB在早期糖尿病肾病中的诊断价值及其与外周血MCP-1表达的关系

Diagnosis of urine RBP and ALB in early diabetic nephropathy and its relationship with MCP-1 expression in peripheral blood

目的分析尿液视黄醇结合蛋白(RBP)、白蛋白(ALB)在早期糖尿病肾病(DN)中的诊断价值及与外周血核细胞趋化蛋白-1(MCP-1)表达的关系。方法选择2015年9月—2017年12月空军军医大学唐都医院肾脏内科收治的2型糖尿病(DM)患者86例作为研究对象,按照患者24 h尿蛋白排泄率的不同分为单纯DM组(46)和早期DN组(40例),另取同期来院检查的健康人42例作为健康对照组,比较3组受试者尿液RBP、ALB水平以及RBP、ALB和RBP+ALB联合诊断阳性率。观察各组外周血MCP-1表达情况,并分析尿液RBP、ALB与血MCP-1的相关性。结果早期DN组、单纯DM组与健康对照组患者的尿液RBP、ALB水平以及外周血MCP-1均逐渐降低,差异均有统计学意义(F/P=40234.35/<0.001、1 975. 16/<0.01、162.46/<0.01)。Ⅰ期、Ⅱ期、Ⅲ期DN患者的尿液RBP、ALB水平以及外周血MCP-1呈现逐渐升高的趋势(F/P=9 177. 06/<0. 001、564. 27/<0. 001、39. 59/<0. 01)。RBP+ALB联合诊断的阳性率为88. 37%,明显高于RBP和ALB单独诊断的阳性率67. 44%,差异具有统计学意义(χ~2/P=10.944/0. 001)。糖尿病肾病患者的尿液RBP和ALB与外周血MCP-1表达均呈正相关(r/P=0. 457/0. 000、0. 483/0. 032)。尿RBP、ALB及RBP+ALB联合诊断早期DN的ROC曲线下面积分别为0. 720、0. 743、0. 982,同时RBP+ALB联合诊断的敏感度以及特异度明显较高。结论尿液RBP+ALB联合诊断早期糖尿病肾病的ROC曲线下面积较大,临床诊断价值较高,并与外周血MCP-1表达呈正相关,可以较为灵敏地反映患者的肾功能损伤。

Objective To investigate the relationship between urinary retinol-binding protein (RBP) and albumin (ALB) in early diabetic nephropathy and its relationship with peripheral blood (nuclear cell chemoattractant protein-1) MCP-1 expression. Methods We selected 86 patients with type 2 diabetes admitted to our hospital from September 2015 to December 2017 as the study subjects, according to the 24-hour urinary protein excretion rate of patients, they were divided into two groups: simple diabetes group (46 cases) and early diabetic nephropathy group (40 cases), and 42 healthy persons from the same period were taken as the control group, the urinary RBP and ALB levels and related diagnostic positivity rates were compared between groups. The expression of MCP-1 in peripheral blood was observed between the groups of patients, and the correlation between urinary RBP,ALB and blood MCP-1 was analyzed. Results The urine RBP, ALB level and peripheral blood MCP-1 in the early diabetic renal group, the simple diabetes group and the control group decreased gradually,the difference was statistically significant ( F/P =40 234.35/<0.001, F/P =1 975.16/<0.001, F/P =162.46/<0.001).The urine RBP,ALB level and peripheral blood MCP-1 of patients with stage I to stage III were gradually increased ( F/P =9 177.06/<0.001, F/P =564.27/<0.001, F/P =39.59/<0.001). The positive rate of RBP+ALB combined diagnosis was 88.37%,which was significantly higher than the positive rate of RBP and ALB alone diagnosed of 67.44%(χ^2/ P =10.944/0.001). The difference was statistically significant. Urinary RBP ( r/P =0.457/0.000) and ALB ( r/P =0.483/0.032) were positively correlated with peripheral blood MCP-1 e xpression in patients with diabetic nephropathy. The urinary RBP, ALB and RBP + ALB combined diagnosis of early DN was 0.720, 0.743, and 0.982, respectively. The sensitivity and specificity of RBP + ALB were significantly higher. Conclusion The combined use of urinary RBP+ALB in the diagnosis of early diabetic nephropathy has a larger area under the ROC curve and a higher diagnostic value, it is positively correlated with the expression of MCP-1 in peripheral blood, which can reflect the renal function impairment more sensitive,effectively avoid or delay the occurrence of diabetic nephropathy, and improve the quality of life of patients.