糖尿病肾病患者血清尿酸、同型半胱氨酸水平和尿白蛋白排泄率变化及临床意义

Clinical significance of the changes of serum uric acid,homocysteine levels and urinary albumin excretion rate in patients with diabetic nephropathy

目的探讨糖尿病肾病(DN)患者尿白蛋白排泄率(UAER)及血清尿酸(SUA)、同型半胱氨酸(Hcy)水平变化及临床意义。方法选择2016年2月至2018年2月南阳市中心医院收治的2型糖尿病患者95例为研究对象,根据24 h UAER将患者分为单纯糖尿病组(UAER<30 mg·24 h^-1,n=28)、早期DN组(30 mg·24 h^-1≤UAER<300 mg·24 h^-1,n=31)、DN组(UAER≥300 mg·24 h^-1,n=36);另选择同期体检健康者32例作为健康对照组。检测各组受试者血清Hcy、SUA水平及24 h尿白蛋白水平,并计算UAER;对4组受试者血清Hcy、SUA水平及UAER进行比较,DN患者血清Hcy、SUA水平与UAER的相关性采用Pearson相关,采用logistic回归分析糖尿病患者肾损伤的危险因素,采用受试者工作特征(ROC)曲线分析血清Hcy、SUA水平及UAER对DN的诊断价值。结果单纯糖尿病组、早期DN组和DN组患者UAER及血清Hcy、SUA水平显著高于健康对照组(P<0.05);早期DN组患者UAER及血清Hcy、SUA水平高于单纯糖尿病组(P<0.05);DN组患者UAER及血清Hcy、SUA水平显著高于单纯糖尿病组和早期DN组(P<0.05)。Pearson相关分析结果显示,DN患者血清Hcy、SUA水平与UAER呈正相关(r=0.728、0.685,P<0.05)。Logistic回归分析显示,血清Hcy、SUA水平及UAER升高是糖尿病患者肾损伤的独立危险因素(P<0.05)。ROC曲线分析显示,UAER及血清Hcy、SUA水平诊断DN的曲线下面积分别为0.833、0.803、0.842,3项联合检测诊断DN的曲线下面积为0.924。3项指标单独检测对DN均具有一定的诊断价值,3项指标联合检测对DN的诊断价值更高。结论血清Hcy、SUA与DN的发生、发展有关,是DN的危险因素;血清Hcy、SUA水平与UAER呈正相关,三者联合检测对DN具有一定的诊断价值。

Objective To investigate the clinical significance of the changes of urinary albumin excretion rate(UAER)and serum uric acid(SUA),homocysteine(Hcy)levels in patients with diabetic nephropathy(DN).Methods Ninety-five patients with type 2 diabetes mellitus admitted to Nanyang Central Hospital from February 2016 to February 2018 were selected as the subjects.According to 24 h UAER,the patients were divided into simple diabetes group(UAER<30 mg·24 h^-1,n=28),early DN group(30 mg·24 h^-1<UAER<300 mg·24 h^-1,n=31)and DN group(UAER<300 mg·24 h^-1,n=36);and 32 healthy persons in the same period were selected as healthy control group.The levels of serum Hcy,SUA and 24 h urinary albumin were measured,and the UAER was calculated.The levels of serum Hcy,SUA and UAER were compared among the four groups.The correlation between serum Hcy,SUA levels and UAER in DN patients was analyzed by Pearson correlation.The risk factors for renal injury in diabetic patients were analyzed by logistic regression.The diagnostic value of serum Hcy,SUA levels and UAER for DN was analyzed by receiver operating characteristic(ROC)curve.Results The UAER and serum Hcy and SUA levels in the simple diabetes mellitus group,early DN group and DN group were significantly higher than those in the healthy control group(P<0.05).The UAER and serum Hcy and SUA levels in the early DN group were higher than those in the simple diabetes group(P<0.05).The UAER and serum Hcy and SUA levels in the DN group were significantly higher than those in the simple diabetes group and early DN group(P<0.05).Pearson correlation analysis showed that the serum Hcy and SUA levels were positively correlated with UAER in DN patients(r=0.728,0.685;P<0.05).Logistic regression analysis showed that the elevated levels of serum Hcy,SUA and UAER were the independent risk factors for renal injury in patients with diabetes mellitus(P<0.05).ROC curve analysis showed that the area under the curve of UAER and serum Hcy and SUA levels for the diagnosis of DN was 0.833,0.803 and 0.842,respectively.The area under the curve of the combined detection of three indexes for diagnosis of DN was 0.924.The detection of single index has certain diagnostic value for DN,and the combined detection of the three indexes has higher diagnostic value for DN.Conclusion Serum Hcy and SUA levels are related to the occurrence and development of DN,and they are the risk factors for DN.The serum Hcy and SUA levels were positively correlated with UAER,and the combined detection of them has certain diagnostic value for DN.