血清铁调素-25、fetuin-A及尿GAL检测对糖尿病肾病的早期诊断价值

Early diagnostic value of serum hepcidin-25,fetuin-A and urinary GAL on diabetic nephropathy

目的:探讨血清铁调素-25(hepcidin-25)、胎球蛋白-A(fetuin-A)及尿β-半乳糖苷酶(GAL)检测对糖尿病肾病的早期诊断价值。方法:抽取2018年1月至2019年12月河南省直第三人民医院收治的2型糖尿病(T2DM)患者130例,其中尿蛋白/肌酐比值(ACR)<30μg/mg 56例(正常尿蛋白,NA组),30μg/mg≤ACR<300μg/mg 45例(微量尿蛋白,MA组),ACR≥300μg/mg 29例(大量尿蛋白,OA组)。另抽取同期体检合格的健康者50例。比较受试者hepcidin-25、fetuin-A及尿β-半乳糖苷酶(GAL)水平,绘制受试者工作特征曲线分析单项及联合指标的诊断效能。结果:T2DM患者血清hepcidin-25、fetuin-A及尿GAL水平高于健康者(P<0.05)。随着ACR水平增加,T2DM患者血清hepcidin-25、fetuin-A及尿GAL水平依次上升,组间比较差异有统计学意义(P<0.05)。三项指标联合诊断效能最高(AUC=0.875,95%CI 0.811~0.939),单项指标以血清hepcidin-25对早期糖尿病肾病的诊断效能较高(AUC=0.837,95%CI 0.773~0.901),其次为尿GAL、血清fetuin-A。结论:血清hepcidin-25、fetuin-A及尿GAL在诊断早期糖尿病肾病中均具有良好的应用效果,三者联合能提高诊断效能。

Objective To investigate the early diagnostic value of serum hepcidin-25,fetuin-A and urinary galactosidase(GAL)on diabetic nephropathy(DN).Methods A total of 130 patients with type 2 diabetes mellitus(T2DM)admitted to the Third Henan Provincial People’s Hospital from January 2018 to December 2019 were selected.Among them,there were 56 cases with urine protein/creatinine ratio(ACR)<30μg/mg(normal albuminuria,NA group),and 45 cases with 30μg/mg≤ACR<300μg/mg(micro albuminuria,MA group),29 cases with ACR≥300μg/mg(overt albuminuria,OA group).Another 50 healthy individuals who passed the physical examination were selected.The subjects’serum hepcidin-25,fetuin-A and urinary beta-galactoside enzymes(GAL)levels were compared,and the ROC curve was drawn to analyze the diagnostic performance of single and combined indicators.Results Serum hepcidin-25,fetuin-A and urinary GAL levels in T2DM patients were higher than those in healthy patients(P<0.05).With the increase of ACR levels,serum hepcidin-25,fetuin-A and urinary GAL levels in T2DM patients increased sequentially,and the differences were significant between the groups(P<0.05).The diagnosis efficacy of the combined of the three indicators was the highest(AUC=0.875,95%CI 0.811-0.939).Serum hepcidin-25 as a single index had higher diagnostic efficacy for early diabetic nephropathy(AUC=0.837,95%CI 0.773-0.901),followed by urine GAL,serum fetuin-A.Conclusions Serum hepcidin-25,fetuin-A and urinary GAL have good application effects in the diagnosis of early diabetic nephropathy,and the combination of the three can improve the diagnostic efficiency.