应用ROC曲线评价Hcy和CysC联合检测对糖尿病肾病的诊断价值

Evaluation of the diagnostic value of combined detection of serum Hcy and CysC for diabetic kidney disease by ROC curve

目的探讨应用受试者工作曲线(ROC曲线)评价血清同型半胱氨酸(Hcy)和胱抑素C(CysC)联合检测对早期糖尿病肾病的诊断价值。方法分别用酶循环法和胶乳免疫比浊法检测单纯糖尿病组(n=48)、早期糖尿病肾病组(n=47)和临床糖尿病肾病组(n=44)血清Hcy和CysC水平,采用单因素方差分析比较多组间检测指标的差异,组间两两比较采用SNK-q检验,应用ROC曲线分析所观察指标在早期糖尿病肾病中的诊断效能。结果临床糖尿病肾病组Hcy、CysC水平明显高于早期糖尿病肾病组以及单纯糖尿病组,GFR水平明显低于早期糖尿病肾病组及单纯糖尿病组,差异有统计学意义(P<0.05);早期糖尿病肾病组Hcy、CysC水平明显高于单纯糖尿病组,GFR水平低于单纯糖尿病组,差异有统计学意义(P<0.05);各指标组间两两比较差异均有统计学意义(P<0.05);Hcy和CysC联合检测在早期糖尿病肾病组的灵敏度明显提高(91.49%),与单项检测比较,差异有统计学意义(P<0.05);早期糖尿病肾病组的Hcy、CysC以及联合检测在ROC曲线下的面积分别为0.766(95%CI:0.670~0.861)、0.833(95%CI:0.753~0.913)、0.898(95%CI:0.838~0.957),联合检测性能优于单项检测。结论应用ROC曲线分析评价联合检测血清Hcy和CysC,结果表明联合检测可提高早期糖尿病肾病诊断的灵敏度和诊断效能。

Objective To investigate the value of combined detection of serum homocysteine(Hcy)and cystatinC(CysC)in diabetic kidney disease by receiver operating characteristic curve(ROC curve).Methods Serum levels of Hcy and CysC were measured by enzyme circulation method and latex immunoturbidimetric assay in the simple diabetes mellitus group(n=48),early diabetic kidney disease group(n=47)and clinical diabetic kidney disease group(n=44),respectively.The statistical difference among the detection indicator of three groups were compared by one-way ANOVA,SNK-q test was used to pairwise comparison between groups.The diagnostic performance of the observed indicators were evaluated by ROC analysis in early diabetic kidney disease.Results The levels of Hcy and CysC in the clinical diabetic kidney disease group were significantly higher than those in the early diabetic kidney disease group and the simple diabetes group,and the level of GFR was significantly lower than those of the early diabetic kidney disease group and the simple diabetes group,the difference was statistically significant(P<0.05);The levels of Hcy and CysC in the early diabetic kidney disease group were significantly higher than those in the simple diabetes group,and the level of GFR was significantly lower than those of the simple diabetes mellitus group,the difference was statistically significant(P<0.05).The sensitivity of combined detection of Hcy and CysC in the early diabetic kidney disease group was significantly improved(91.49%),and the difference was statistically significant(P<0.05).The area of Hcy,CysC and combined detection in the early diabetic kidney disease group under the ROC curve were 0.766(95%CI:0.670-0.861),0.833(95%CI:0.753-0.913),0.898(95%CI:0.838-0.957).The combined detection performance was better than single detection.Conclusion ROC curve analysis is used to evaluate the combined detection of Hcy and CysC in serum.The results showed that the combined detection could improve the sensitivity and diagnostic efficiency of early diabetic kidney disease.