四项生化指标联合检测在糖尿病早期肾损伤诊断中的临床价值

Clinical value of combined detections of four biochemical indexes in diagnosis of early renal injury in diabetes mellitus

目的观察血清胱抑素C(CysC)、β2微球蛋白(β2-MG)、视黄醇结合蛋白(RBP)、尿微量白蛋白(mALB)联合检测在糖尿病(DM)早期肾损伤诊断中的临床价值。方法回顾性分析2018年6月—2019年5月于本院治疗的106例DM患者临床资料,并依据尿微量白蛋白排泄率(UARE)将其分为DM无肾病组(UARE<20μg/min,35例)、DM早期肾病组(UARE:20~200μg/min,37例)、糖尿病肾病(DN)组(UARE>200μg/min,34例)。检测并比较各组CysC、β2-MG、RBP、mALB水平,计算各指标单项及联合检出阳性率。结果DN组CysC(1.79±0.65)mg/L、β2-MG(3.74±0.80)mg/L、RBP(113.69±32.87)mg/L、mALB(271.63±45.28)μg/min>DM早期肾病组(1.33±0.54)mg/L、(3.21±0.60)mg/L、(79.18±15.30)mg/L、(45.98±12.22)μg/min>DM无肾病组(0.88±0.26)mg/L、(1.59±0.37)mg/L、(63.52±14.76)mg/L、(11.83±5.10)μg/min,差异有统计学意义(P<0.05);CysC+β2-MG+RBP+mALB检出阳性率(89.62%)高于较各单项(65.09%、58.49%、67.92%、71.70%),差异有统计学意义(P<0.05);CysC+β2-MG+RBP+mALB联合诊断AUC值可达0.887,具有较高的诊断价值。结论CysC、β2-MG、RBP、mALB为糖尿病早期肾损伤诊断中敏感指标,且将各指标联合检测有利于及早诊断肾损伤及其严重程度。

Objective To evaluate the clinical value of the combined detections of four biochemical indexes,serum cystine C(CysC),β2 microglobulin(β2 MG),retinol binding protein(RBP),and urinary microalbumin(mALB),in the diagnosis of early renal injury in diabetes mellitus(DM).Methods The clinical data of 106 patients with DM treated in a hospital from June 2018 to May 2019 were collected and analyzed retrospectively,and according to the urinary albumin excretion rate(UAER),they were divided into a DM without nephropathy group(UAER<20μg/min,35 case),a DM with early nephropathy group(UAER:20-200μg/min,37 cases),and a DM with nephropathy group(UAER>200μg/min,34 cases).The levels of CysC,β2-MG,RBP,and mALB were detected and the positive detection rate of each index and the positive rate of the combined detections were calculated and compared.Results In the DM with nephropathy group,the CysC was(1.79±0.65)mg/L,β2-MG was(3.74±0.80)mg/L,RBP was(113.69±32.87)mg/L,and mALB was(271.63±45.28)μg/min,which>the DM with early nephropathy group[(1.33±0.54)mg/L,(3.21±0.60)mg/L,(79.18±15.30)mg/L,and(45.98±12.22)μg/min]>the DM without nephropathy group[(0.88±0.26)mg/L,(1.59±0.37)mg/L,(63.52±14.76)mg/L,and(11.83±5.10)μg/min],and the difference was statistically significant(P<0.05).The positive rate of the combined detections(CysC,β2MG,RBP,and mALB)was 89.62%,which was higher than that of the individual item(65.09%,58%,67.92%,and 71.70%respectively),and there was a significant difference(P<0.05).The AUC value of CysC+β2-MG+RBP+mALB combined diagnosis was relatively high(0.887).Conclusion CysC,β2-MG,RBP and ALB are sensitive indexes in the diagnosis of early renal injury in DM,and the combined detections of these indexes are conducive to the early diagnosis of renal injury and its severity.