U-mALB及血清Cys-C、β2-MG检测在2型糖尿病肾病早期诊断及预后评估中的应用

Clinical Application of U-mALB,Serum Cys-C and Serum β2-MG Detection in Early Diagnosisand Prognostic Evaluation of Type 2 Diabetic Nephropathy

目的探讨尿微量白蛋白(U-mALB)及血清胱抑素C(Cys-C)、β2微球蛋白(β2-MG)检测在2型糖尿病肾病(DN)患者早期诊断及预后评估中的应用价值。方法选取115例2型糖尿病患者为研究对象,根据尿白蛋白排泄率(UAER)不同将患者分为单纯糖尿病组(DM组)41例、早期糖尿病肾病组(早期DN组)45例和临床糖尿病肾病组(临床DN组)29例,另选取同期进行健康体检者50例为对照组,采用免疫比浊法检测各组U-mALB及血清Cys-C、β2-MG水平。结果临床DN组、早期DN组和单纯DM组血清Cys-C、β2-MG和U-mALB水平均高于对照组(均P<0.05);早期DN组Cys-C、β2-MG和U-mALB水平高于DM组,差异有统计学意义(均P<0.05);早期DN组血清Cys-C、β2-MG和U-mALB阳性率高于单纯DM组(均P<0.05);预后良好组U-mALB及血清β2-MG、Cys-C水平低于预后不良组(均P<0.05)。血清Cys-C、β2-MG、U-mALB诊断早期DN的ROC曲线下面积(AUC)分别为0.914、0.862、0.889,均有良好的诊断效能。结论U-mALB及血清Cys-C、β2-MG可用于DN的早期诊断和预后评估,均有良好的诊断效能,且以血清Cys-C特异性、灵敏度和诊断效能最高。

Objective To investigate the value of urinary microalbumin(U-mALB),serum cystatin C(Cys-C) and serum β 2-macroglobulin(β 2-MG) detection in early diagnosis and prognosticevaluation of type 2 diabetic nephropathy(DN). Methods According to the urinary albumin excretion rate,115 patients with type 2 diabetes mellitus(DM) were divided into DM group( n =41),early DN group( n =45) and clinical DN group( n =29). In addition,50 healthy subjects were selected as the control group. The levels of urinary U-mALB,serum Cys-C and serum β 2-MG were detected using immunoturbidimetry. Results The levels of Cys-C,β 2-MG and U-mALB in clinical DN group,early DN group and DM group were higher than those in control group,and those in early DN group were higher than those in DM group( P <0.05).The positive rates of Cys-C,β 2-MG and U-mALB in early DN group were higher than those in DM group( P <0.05). Furthermore,the levels of Cys-C,β 2-MG and U-mALB in favorable prognosis group were lower than those in poor prognosis group( P <0.05).The area under ROC curve was 0.914 for Cys-C,0.862 for β 2-MG and 0.889 for U-mALB in diagnosing early DN. Conclusion U-mALB,serum Cys-C and serum β 2-MG detection can be used for early diagnosis and prognosis assessment of DN. Among the three indicators,serum Cys-C has the highest specificity,sensitivity and diagnostic efficiency.