外周血及尿液中相关指标在中老年早期糖尿病肾病中的研究

Study on related indexes of peripheral blood and urine in early diabetic nephropathy in middle-aged and elderly patients

目的:分析外周血同型半胱氨酸(Hcy)、胱抑素C(CysC)、超氧化物歧化酶(SOD)及尿视黄醇结合蛋白(RBP)、白蛋白(ALB)在中老年早期糖尿病肾病(DKD)鉴别诊断中的应用。方法:将2017年1月—2020年5月收治的84例2型糖尿病(DM)患者。按照患者24 h尿蛋白排泄率的不同分为单纯DM组(44例)和DKD组(40例),另取同期来院体检的健康者41例为对照组,比较3组受试者外周血Hcy、CysC、SOD及尿液中RBP、ALB水平。结果:外周血Hcy、CysC及尿液RBP、ALB水平DKD组>DM组>对照组,SOD水平DKD组Ⅱ期>Ⅰ期,SOD水平Ⅲ期<Ⅱ期<Ⅰ期,差异有统计学意义(P<0.05)。血清Hcy、CysC水平及尿液RBP、ALB水平均与肾小球滤过率(GFR)水平呈负相关,SOD与GFR水平呈正相关(P<0.05)。外周血Hcy、CysC、SOD及尿液RBP、ALB联合诊断的敏感性及特异性明显升高。结论:外周血Hcy、CysC、SOD及尿液RBP、ALB联合检测对于早期DKD有很好的诊断价值,可以较为灵敏地反映患者的肾功能损伤。

Objective:To analyze the application of peripheral blood homocysteine(Hcy),Cystatin C(CysC),superoxide dismutase(SOD),urinary retinol binding protein(RBP)and albumin(ALB)in the differential diagnosis of early diabetic nephropathy(DKD)in middle-aged and elderly patients.Methods:From January 2017 to May 2020,84 patients with type 2 diabetes mellitus(DM)in our hospital were selected.The patients were divided into DM group(44 cases)and DKD group(40 cases)according to their 24-hour urinary protein excretion rate.Another 41 healthy people who came to the hospital for physical examination at the same time were selected as the healthy control group.The levels of Hcy,CysC,SOD in peripheral blood,RBP and ALB in urine were compared among the three groups.Results:The levels of Hcy,CysC,RBP and ALB were higher in DKD group than those in DM group and healthy control group,and SOD level was lower in DKD group than that in DM group and healthy control group(P<0.05).The levels of Hcy,CysC in peripheral blood and RBP and ALB in urine in stageⅢwere higher than those in stageⅡand stageⅠ,and the level of SOD in stageⅢwere lower than that in stageⅡand stageⅠ,and the differences were statistically significant(P<0.05).Serum Hcy,CysC levels and urine RBP,ALB levels were negatively correlated with GFR levels,SOD was positively correlated with GFR levels(P<0.05).The sensitivity and specificity of Hcy,CysC and SOD in peripheral blood,RBP and ALB in urine were significantly increased.Conclusion:The combined detection of Hcy,CysC and SOD in peripheral blood,RBP and ALB in urine may have a good diagnostic value for early diabetic nephropathy,which can more sensitively reflect the renal function damage of patients.