尿ZAG、KIM-1和NGAL联合检测在糖尿病肾病诊断中的价值

Diagnostic value of urinary ZAG,KIM-1 and NGAL in diabetic nephropathy

目的探讨尿液中锌-α-2-糖蛋白(ZAG)、肾损伤分子1(KIM-1)和中性粒细胞明胶酶相关脂质运载蛋白(NGAL)联合检测在糖尿病肾病中的诊断价值。方法选取2018年1-12月在南京医科大学附属淮安第一医院确诊的单纯糖尿病患者43例为糖尿病对照组;糖尿病肾病患者77例,按照清晨尿标本清蛋白/肌酐比值(UACR)分为2组,糖尿病微量清蛋白尿组(38例,UACR 30~300 mg/g)、糖尿病大量清蛋白尿组(39例,UACR>300 mg/g)。并选取同期体检健康者38例为健康对照组。收集研究对象24 h尿液,利用酶联免疫吸附测定检测尿液中ZAG、KIM-1及NGAL的水平。评估ZAG、KIM-1及NGAL与临床指标的相关性,并通过受试者工作特征曲线分析3项指标联合检测的诊断效能。结果糖尿病肾病患者尿液中ZAG、KIM-1和NGAL水平均高于体检健康者,差异有统计学意义(P<0.05)。尿液中的ZAG、KIM-1和NGAL水平均与UACR、mAlb及糖尿病病程呈正相关,与估算肾小球滤过率呈负相关。3项指标联合检测的诊断效能均高于某1项指标单独检测。结论尿液中的ZAG、KIM-1和NGAL水平对诊断糖尿病肾病有较高的临床价值,3项指标联合检测诊断效能更高。

Objective To investigate the diagnostic value of combined detection of zinc-α-2-glycoprotein(ZAG),kidney injury molecule-1(KIM-1)and neutrophil gelatinase associated lipocalin(NGAL)in diabetic nephropathy.Methods A total of 43 patients with simple diabetes mellitus diagnosed in the Huai′an First Hospital Affiliated to Nanjing Medical University from January to December 2018 were selected as the control group;77 patients with diabetic nephropathy were divided into two groups according to the ratio of albumin to creatinine(UACR)in the morning urine samples,the microalbuminuria group(38 cases,UACR 30-300 mg/g)and the diabetic macroalbuminuria group(39 cases,UACR>300 mg/g).Meanwhile,38 healthy people in the same period were selected as the healthy control group.24 h urine samples were collected and the levels of ZAG,KIM-1 and NGAL in urine were detected by enzyme-linked immunosorbent assay.The correlation of ZAG,KIM-1 and NGAL with biochemical indexes were evaluated,and the diagnostic efficacy of combined detection of the three indicators were analyzed by receiver operating characteristic curve.Results The levels of ZAG,KIM-1 and NGAL in the urine of diabetic nephropathy patients were higher than those of healthy people(P<0.05).The levels of ZAG,KIM-1 and NGAL in urine positively correlated with UACR,mAlb and the course of diabetes,but negatively correlated with estimated glomerular filtration rate.The diagnostic efficiency of combined detection of three indicators was higher than that of a single index.Conclusion The levels of ZAG,KIM-1 and NGAL in urine are of high clinical value in the diagnosis of diabetic nephropathy,and the combined detection of the three indicators is more effective.