尿MA联合血清TRFα1-MG胱抑素C检测在糖尿病早期肾损伤诊断中的应用

Application of Urine MA Combined with Serum TRFα1-MG and Cystatin C in the Diagnosis of Early Kidney Injury of Diabetes Mellitus

目的:探讨尿微量白蛋白(Microalbumin,MA)联合血清转铁蛋白(Transferrin,TRF)、血清α1-微球蛋白(α1-Microglobulin,α1-MG)、血清胱抑素C在糖尿病早期肾损伤诊断中的应用价值。方法:选取2018年10月至2020年1月122例糖尿病住院患者,根据患者是否发生早期肾损伤分为两组,54例糖尿病患者发生早期肾损伤设为A组,68例糖尿病患者未发生早期肾损伤设为B组,选取同期健康体检人群50例设为对照组(C组)。所有研究对象留取中段尿测定尿MA水平,抽取静脉血测定血清TRF、α1-MG和胱抑素C水平。比较各组患者上述指标水平及阳性检出率,以ROC曲线法分析各指标对糖尿病早期肾损伤的诊断效能。结果:A组、B组、C组三组间的尿MA、血清TRF、血清α1-MG、血清胱抑素C水平及阳性检出率比较差异均有统计学意义(F=229.053,P<0.001;F=76.828,P<0.001;F=87.632,P<0.001;F=47.151,P<0.001;χ2=91.652,P<0.001;χ2=69.050,P<0.001;χ2=75.260,P<0.001;χ2=78.732,P<0.001)。尿MA、血清TRF、血清α1-MG、血清胱抑素C诊断糖尿病早期肾损伤的灵敏度分别为95.40%、81.50%、75.40%、81.50%,特异度分别为80.70%、66.70%、87.70%、89.50%;四项指标联合诊断的灵敏度为96.92%,特异度为49.12%(AUC=0.900,95%CI=0.846-0.954)。结论:尿MA联合血清TRF、α1-MG、胱抑素C检测对糖尿病早期肾损伤具有较高的诊断价值,准确性高,对糖尿病肾病的早期筛查及预防具有重要意义。

Objective:To explore the application value of urine microalbumin(MA)combined with serum transferrin(TRF),α1-microglobulin(α1-MG)and cystatin C in the diagnosis of early kidney injury of diabetes mellitus.Methods:122 patients with diabetes mellitus hospitalized between October 2018 and January 2020 were selected and divided into group A(54 case with early kidney injury)group B(68 cases without early kidney injury).Fifty healthy people who completed physical examination in the same period were enrolled as control group(group C).The middle segment urine of all subjects was collected to measure the urine MA level,and venous blood was collected to determine serum TRF,α1-MG and cystatin C levels.The positive detection rates of above indexes were compared among groups.The diagnostic efficiency of all indexes for early kidney injury of diabetes mellitus was analyzed by ROC curves.Results:There were significant differences in urine MA,serum TRF,serumα1-MG,serum cystatin C levels and positive detection rate among groups A,B and C(F=229.053,P<0.001;F=76.828,P<0.001;F=87.632,P<0.001;F=47.151,P<0.001;χ2=91.652,P<0.001;χ2=69.050,P<0.001;χ2=75.260,P<0.001;χ2=78.732,P<0.001).The sensitivities and specificities of urine MA,serum TRF,α1-MG and cystatin C for diagnosis of early kidney injury of diabetes mellitus were(95.40%,81.50%,75.40%,81.50%)and(80.70%,66.70%,87.70%,89.50%),respectively.The sensitivity and specificity of their combined diagnosis were 96.92%and 49.12%(AUC=0.900,95%CI=0.846-0.954).Conclusion:The combined detection of urine MA,serum TRF,α1-MG and cystatin C is of high diagnostic value and high accuracy for early kidney injury of diabetes mellitus,which is of great significance for early screening and prevention of diabetic nephropathy.