尿微量白蛋白与尿肌酐比值、尿微量白蛋白及尿β2-微球蛋白检测诊断妊娠期糖尿病早期肾损害的价值

Diagnostic value of the detection of urine albumin-creatinine ratio,urine microalbumn and urine β2-microglobulin in gestational diabetes mellitus with early renal injury

目的探讨尿微量白蛋白与尿肌酐比值(ACR)、尿微量白蛋白(mALB)、尿β2-微球蛋白(β2-MG)诊断妊娠期糖尿病早期肾损害的价值。方法选择正常孕中晚期孕妇100例为对照组,孕中晚期妊娠期糖尿病孕妇100例为观察组。采用免疫比浊法检测2组尿ACR,采用放射免疫法检测尿mALB、尿β2-MG水平,采用常规法测尿蛋白水平,采用脲酶法检测血清尿素氮(BUN)水平,采用苦味酸法检测血清肌酐(Cr)水平;以尿ACR≥3.0mg/mmol,尿mALB≥30mg/24h,尿β2-MG≥0.3mg/L,尿蛋白以干化学试纸条法显示变色为阳性,血BUN、Cr水平高于试剂说明中的参考值上线为阳性,计算2组上述各指标阳性率;应用受试者工作特征(ROC)曲线评价尿ACR、mALB、β2-MG预测妊娠期糖尿病孕妇早期肾损害的曲线下面积及敏感性。结果观察组尿ACR、尿mALB、尿β2-MG水平及阳性率均明显高于对照组(P均<0.05);2组血清BUN、Cr水平和阳性率比较差异均无统计学意义(P均>0.05)。尿ACR、尿mALB、尿β2-MG、尿ACR与mALB与β2-MG联合检测的曲线下面积分别为0.916,0.753,0.740,0.888,95%CI分别为[0.846,0.987],[0.632,0.875],[0.613,0.867],[0.802,0.973],差异均有统计学意义(P均<0.05)。结论联合检测尿ACR、尿mALB、尿β2-MG对诊断妊娠期糖尿病早期肾损害有重要价值。

Objective It is to explore the diagnosis value of urine albumin-creatinine ratio (ACR),urine microalbumin (mALB),urine β 2-microglobulin (β 2-MG) for gestational diabetes mellitus (GDM) with early diabetic nephropathy. Methods 100 normal pregnant women in middle and late pregnancy were selected as control group, and 100 pregnant women with GDM in middle and late pregnancy were selected as observation group. The urine ACR was measured by immunoturbidimetry, the urine mALB and urine β 2-MG were measured by radioimmunoassay,the urine protein was measured by conventional method,the BUN was measured by urease methodthe,and the serum Cr was detected by picric acid method in the two groups. The results were positive if urinary ACR≥3.0 mg/mmol,urinary mALB≥30 mg/24 h,urinary β 2-MG ≥0.3 mg/L, urinary protein discoloration by dry chemical strip method, blood BUN and Cr levels was higher than the upper line of reference value in the reagent instructions, the positive rates of every indexes abvove were calculated in the two groups;The area under curve(AUC) and sensitivity of urine ACR, mALB and β 2-MG about prediction early renal injury of GDM were evaluated by receiver-operating characteristic(ROC)curve. Results The levels and positive rates of urine ACR, mALB and β 2-MG in GDM group were significantly higher than those of control group( P <0.05),the levels and positive rates of BUN and Cr had no significant difference between the two groups( P >0.05).The receiver-operating characteristic curve analysis showed that the area under curve(AUC) of urine ACR, mALB,β 2-MG and joint detection of urine ACR, mALB,β 2-MG were 0.916,0.753, 0.740 and 0.888 respectively;and 95%CI were [0.846,0.987],[0.632,0.875],[0.613,0.867] and [0.802,0.973] respectively,the difference was statistically significant( P <0.05). Conclusion The combined detection of urine ACR,urine mALB and urine β 2-MG has an important clinical value for diagnosing early renal injury of GDM.