胱抑素C、β2微球蛋白、尿酸在糖尿病肾病早期诊断中的价值

The value of cystatin-C,β2 microglobulin and uric acid in the early diagnosis of diabetic nephropathy

目的探讨胱抑素C(Cys-C)、β2微球蛋白(β2m)、尿酸(UA)在糖尿病肾病早期诊断中的价值。方法通过医疗大数据平台检索糖尿病肾病患者的临床资料,根据相应的诊断标准,将患者分为糖尿病肾病(DN)组与非糖尿病肾病(NDN)组,采用受试者工作(ROC)曲线评价Cys-C、β2m、UA在糖尿病肾病早期诊断中的价值。结果共检索到2 178例患者,DN组244例,NDN组1 934例,DN组的Cys-C、β2m、UA水平均高于NDN组(P <0.05),且随着DN的进展,Cys-C、β2m、UA水平均逐渐升高(P <0.05);单项诊断曲线下面积β2m(0.888)> Cys-C(0.875)> UA(0.721),2项联合诊断曲线下面积Cys-C&β2(0.902)>β2m&UA(0.895)> Cys-C&UA(0.890),但差异均无统计学意义(P>0.05),3项联合诊断的曲线下面积最高,为0.91,且其灵敏度(83.20%)、约登指数(0.652 5)均较高于单项及2项联合诊断,其诊断价值优于2项联合与单项诊断。结论在糖尿病肾病早期诊断中,单项诊断价值β2m> Cys-C>UA,3项联合诊断价值优于2项联合与单项诊断。

Objective To explore the value of cystatin-C( Cys-C),β2 microglobulin( β2 m) and uric acid( UA) in the early diagnosis of diabetic nephropathy. Methods The clinical data of patients with diabetic nephropathy were retrieved through the medical data platform. According to the corresponding diagnostic criteria,the patients were divided into diabetic nephropathy( DN) group and non-diabetic nephropathy( NDN) group,and the value of β2 m,Cys-C and UA in the early diagnosis of diabetic nephropathy was evaluated by subject work( ROC) curve. Results A total of 2 178 patients were retrieved,with 244 in the DN group and 1934 in the NDN group. The levels of Cys-C,β2 m and UA in DN group were higher than those in NDN group( P < 0. 05). With the progress of DN,the levels of Cys-C,β2 m and UA increased gradually,and the differences between the groups were statistically significant( P < 0. 05). The area under the single diagnosis curve was β2 m( 0. 888) > Cys-C( 0. 875) > UA( 0. 721),and the area under the two combined diagnostic curves was Cys-C&β2( 0. 902) > β2 m&UA( 0. 895) > Cys-C&UA( 0. 890),but the difference was not statistically significant( P >0. 05). The area under the curve for the three joint diagnoses is up to 0. 91,and its sensitivity( 83. 20%) and Yoden index( 0. 652 5) were higher than the single and two combined diagnosis. The diagnostic value of the three joint diagnoses was better than the two combined and single diagnosis. Conclusion In the early diagnosis of diabetic nephropathy,the single diagnosis value β2 m >Cys-C > UA and the value of the three joint diagnoses are better than the two combined and single diagnosis.