糖尿病肾病病人尿外泌体DPP-4、Cys C、α1-MG和转铁蛋白联合检测的临床价值

Clinical value of the combined detection of urinary exosome DPP-4,Cys C,α1-MG and transferrin in patients with diabetic nephropathy

目的:探讨糖尿病肾病病人尿外泌体二肽基肽酶-4(exosome-DPP-4)、胱抑素C(Cys C)、α1-微球蛋白(α1-MG)和尿转铁蛋白(TRU)联合检测的临床价值。方法:检测40例健康对照组和120例糖尿病病人[正常蛋白尿组(40例)、微量蛋白尿组(40例)和大量蛋白尿组(40例)]尿外泌体DPP-4和尿Cys C、α1-MG、TRU、IgG、微量白蛋白水平,应用Pearson相关分析评价各项目间的相关性,采用受试者工作特征曲线评估DPP-4、Cys C、α1-MG、TRU、IgG等诊断糖尿病肾病的价值。结果:糖尿病肾病病人尿液外泌体中的DPP-4、尿α1-MG含量高于对照组(P<0.05),且随着尿蛋白含量的增加而上升(P<0.05~P<0.01);Cys C、TRU、IgG水平在正常蛋白尿组与对照组差异无统计学意义(P>0.05),在微量蛋白尿组、大量蛋白尿组Cys C、TRU、IgG水平均高于对照组(P<0.05~P<0.01)。尿外泌体DPP-4与α1-MG、Cys C、TRU、IgG呈正相关关系(P<0.05)。DPP-4、α1-MG、Cys C、TRU、IgG以及DPP-4与α1-MG、Cys C、TRU联合检测水平的受试者工作特征曲线下面积为0.742、0.736、0.843、0.868、0.836和0.899;DPP-4、α1-MG、Cys C及TRU联合检测灵敏度为93.42%,特异度为86.90%,阳性预测值为86.59%,阴性预测值为93.59%。结论:尿外泌体DPP-4、尿Cys C和尿α1-MG、TRU联合检测对糖尿病肾病的早期诊断具有较高的临床价值。

Objective:To investigate the clinical value of the combined detection of urinary exosome dipeptidyl peptidase 4(DPP-4),α1-microglobulin(α1-MG),cystatin C(Cys C)and transferring(TRU)in patients with diabetic nephropathy.Methods:The levels of DPP-4,α1-MG,Cys C,TRU,IgG,microalbuminuria in 120 diabetic patients[including normal proteinuria group(40 cases),microalbuminuria group(40 cases)and massive proteinuria group(40 cases)]and healthy control group(40 cases)were detected.The Pearson correlation analysis was used to evaluate the correlation among the items.The receiver operating characteristic curve was used to evaluate the value of DPP-4,Cys C,α1-MG,TRU and IgG in the diagnosis of diabetic nephropathy.Results:The contents of DPP-4 andα1-MG in urine exosomes of diabetic nephropathy patients were higher than those in control group(P<0.05),and increased with the increasig of urine protein content(P<0.05 to P<0.01).The differences of the levels of Cys C,TRU and IgG between normal albuminuria group and control group were not statistically significant(P>0.05),and the levels of Cys C,TRU and IgG in microalbuminuria group and massive albuminuria group were higher than those in control group(P<0.05 to P<0.01).The urinary exosome DPP-4 was positively correlated withα1-MG,Cys C,TRU and IgG(P<0.05).The areas under the receiver operating characteristic curve of DPP-4,α1-MG,Cys C,TRU,IgG,and combined DPP-4,α1-MG,Cys C and TRU were 0.742,0.736,0.843,0.868,0.836 and 0.899,respectively.The sensitivity,specificity,positive predictive value and negative predictive value of the combined detection of DPP-4,α1-MG,Cys C and TRU were 93.42%,86.90%,86.59%and 93.59%,respectively.Conclusions:The combined detection of urinary exosome DPP-4,urinary Cys C and urinaryα1-MG and TRU has high clinical value in the early diagnosis of diabetic nephropathy.