血清同型半胱氨酸、胱抑素C及β_2微球蛋白联合检测对2型糖尿病肾病的诊断价值

The diagnostic value of combined detection of serum homocysteine, cystain C and β_2-microglobulin in type 2 diabetic nephropathy

目的探讨血清同型半胱氨酸(HCY)、胱抑素C(Cys-C)及β_2微球蛋白(β_2-MG)联合检测对2型糖尿病肾病的诊断价值。方法选择皖北煤电集团总医院2014年12月至2016年5月住院的2型糖尿病肾病病人(DN组)200例。依据尿白蛋白排泄率(UAER)分3组:单纯糖尿病(SDM)组56例、早期糖尿病肾病(EDN)组70例和临床糖尿病肾病(CDN)组74例,并设健康对照组50例。空腹检测血清HCY、Cys-C、β_2-MG含量并对相关参数进行分析评价。结果 DN组病人HCY、Cys-C、β_2-MG、Urea和Cre水平均明显高于健康对照组(P<0.01)。CDN组HCY、Cys-C和β_2-MG水平均明显高于SDM组、EDN组和对照组(P<0.01),EDN组HCY、Cys-C和β_2-MG水平均明显高于SDM组和对照组(P<0.01),SDM组Cys-C和β_2-MG水平均明显高于对照组(P<0.01),SDM组HCY与对照组差异无统计学意义(P>0.05)。ROC曲线下面积HCY+Cys-C+β_2-MG联合检测最大、Cys-C和β_2-MG单独检测次之、HCY单独检测最小。HCY+Cys-C+β_2-MG联合检测的灵敏度、特异度、阳性预测值、阴性预测值、符合率和约登指数分别为88.50、96.00、98.88、67.61、90.00和84.50,其值均高于HCY、Cys-C和β_2-MG单独检测。结论血清HCY、Cys-C及β_2-MG联合检测可以用于评判2型糖尿病肾病的早期损伤及损伤程度,对2型糖尿病肾病的早期诊断和疗效观察具有较高的临床诊断价值。

Objective To discuss the diagnostic value of combined detection of serum homocysteine(HCY),cystain C(Cys-C)andβ2-microglobulin(β2-MG)in type 2 diabetic nephropathy.Methods 200 cases of type 2 diabetic nephropathy(DN)hospitalized during December 2014-2016 May were selected and divided into three groups according to their urinary albumin excretion rate(UAER):56 cases in pure DM patients group,70 cases in early stage DN patients group and 74 cases in clinical stage DN patients group.Besides,another 50 cases of healthy control group were also established.Fasting serum HCY,Cys-C,β2-MG levels were detected,and the related parameters were analyzed and evaluated.Results The HCY,Cys-C,β2-MG,Urea and Cre levels of the DN patients were obviously higher than those of healthy controls(P<0.01).The serum levels of HCY,Cys-C andβ2-MG in group CDN were significantly higher than those in group SDM,EDN and control(P<0.01).The serum levels of HCY,Cys-C andβ2-MG in group EDN were significantly higher than those in the SDM group and the control group(P<0.01),and the serum levels of Cys-C andβ2-MG in the SDM group were significantly higher than those in the control group(P<0.01),however,there was no significant difference between the SDM group and the control group in HCY(P>0.05).The area under the ROC curve:HCY+Cys-C+β2-MG>Cys-C>β2-MG>HCY.The sensitivity,specificity,positive predictive value,negative predictive value,accuracy and Youden index of the combined detection of HCY+Cys-C+β2-MG were 88.50,96.00,98.88,67.61,90.00 and 84.50,the values were higher than those of HCY,Cys-C andβ2-MG detection alone.Conclusions The combined detection of serum HCY,Cys-C andβ2-MG can be used for evaluation of the early damage and damage extent of type 2 diabetic nephropathy,and it has high clinical reference value for early diagnosis of type 2 diabetic nephropathy.