血清Cys-C、β2-MG联合Ccr检测对2型糖尿病患者早期肾损伤的诊断价值

Diagnostic value of serum Cys-C,β2 microglobulin combined with endogenous creatinine clearance rate for early renal injury in patients with type 2 diabetes mellitus

目的分析血清胱抑素C(Cys-C)、β2微球蛋白(β2-MG)联合内生肌酐清除率(Ccr)诊断2型糖尿病(T2DM)早期肾损伤的价值。方法回顾性收集2017年1月~2019年3月我院收治的T2DM病例147例,依据尿白蛋白排泄率(UAER)分为单纯T2DM组62例、微量蛋白尿组59例及临床蛋白尿组26例,比较各组外周血Cys-C、β2-MG、Ccr的差异,受试者工作曲线(ROC)分析三者单独及联合诊断T2DM早期肾损伤的价值。结果单纯T2DM组UAER、Cys-C、β2-MG低于微量蛋白尿组与临床蛋白尿组(P<0.05),Ccr高于微量蛋白尿组与临床蛋白尿组(P<0.05),微量蛋白尿组UAER、Cys-C、β2-MG低于临床蛋白尿组,Ccr高于临床蛋白尿组(P<0.05);Cys-C诊断T2DM早期肾损害曲线下面积(AUC)为0.946,约登指数最大时对应敏感性、特异性分别90.14%、90.32%;其次为Ccr,AUC为0.945,约登指数最大时对应敏感性、特异性分别为84.75%、91.94%,三者联合诊断T2DM早期肾损伤效能最高,AUC为0.951,约登指数最大时对应敏感性、特异性分别为92.14%、92.32%。结论T2DM早期肾损害伴明显Cys-C、β2-MG上升,Ccr降低表现,且三者水平变化与肾损害进展有关,共同参与T2DM肾损害进程,单独Cys-C诊断T2DM早期肾损害效能最高,三者联合诊断效能优于单独诊断。

Objective To analyze diagnostic value of serum cystatin C(Cys-C),β2 microglobulin(β2-MG)combined with endogenous creatinine clearance rate(Ccr)for early renal injury in patients with type 2 diabetes mellitus(T2 DM).Methods A retrospective collection was performed on 147 T2 DM patients who were admitted to the hospital from January 2017 to March 2019.According to urinary albumin excretion rate(UAER),they were divided into simple T2 DM group(n=62),microalbuminuria group(n=59)and clinical proteinuria group(n=26).Cys-C,β2-MG and Ccr in peripheral blood were compared.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of the three alone and their combination for early renal injury in T2 DM patients.Results UAER,Cys-C andβ2-MG in simple T2 DM group were lower than those in microalbuminuria group and clinical proteinuria group(P<0.05),while Ccr in simple T2 DM group was higher than that in microalbuminuria group and clinical proteinuria group(P<0.05).UAER,Cys-C andβ2-MG in microalbuminuria group were lower than those in clinical proteinuria group,while Ccr in microalbuminuria group was higher than that in clinical proteinuria group(P<0.05).The area under curve(AUC)of Cys-C for diagnosis of early renal injury of T2 DM was 0.946.When Yoden index was the greatest,the corresponding sensitivity and specificity were 90.14%and 90.32%,followed by Ccr(AUC=0.945).When Yoden index was the greatest,the corresponding sensitivity and specificity were 84.75%and 91.94%,respectively.The diagnostic efficiency of the three combination for early renal injury of T2 DM was the highest.AUC was 0.951.When Yoden index was the greatest,the corresponding sensitivity and specificity were 92.14%and 92.32%respectively.Conclusion The early renal damage of T2 DM is accompanied with increase of Cys-C andβ2-MG and decrease of Ccr.The changes of the three are related to progression of renal damage,which collectively participate in process of T2 DM renal damage.In single index,diagnostic efficiency of Cys-C is the highest for early renal damage in T2 DM.The diagnostic efficiency of the three combination is superior to single diagnosis.