尿ZAG、KIM-1和NGAL联合检测在糖尿病肾病诊断中的临床价值

The value of combined detection of ZAG,Kim-1 and NGAL in the diagnosis of diabetic nephropathy

目的探究尿锌-α-2-糖蛋白(ZAG)、肾损伤分子1(KIM-1)和中性粒细胞明胶酶相关脂质运载蛋白(NGAL)联合检测在糖尿病肾病(DN)诊断中的临床价值。方法前瞻性选取2018年1月至2020年8月延安大学附属医院收治的80例DN患者作为观察组,将同期常规体检的80名健康体检者作为对照组。检测并对比两组间以及不同疾病进展、不同病程患者尿ZAG、KIM-1和NGAL水平,分析3项指标单独和联合检测对DN的诊断价值。结果观察组患者尿ZAG、KIM-1和NGAL水平为(28.25±3.63)μg/L、(7.84±1.25)ng/mL、(25.34±4.75)μg/L,均明显高于对照组[(12.49±2.74)μg/L、(4.52±0.56)ng/mL、(7.94±1.36)μg/L],差异均有统计学意义(P<0.05);肾功能衰竭组尿ZAG、KIM-1和NGAL水平为(39.33±4.68)μg/L、(10.69±2.54)ng/mL、(45.30±5.75)μg/L,高于临床蛋白尿组[(25.42±3.57)μg/L、(8.43±2.21)ng/mL、(20.48±4.43)μg/L]与微量蛋白尿组[(17.65±2.77)μg/L、(6.42±1.02)ng/mL、(15.53±3.22)μg/L],差异均有统计学意义(P<0.05);病程≥10年组患者尿ZAG、KIM-1和NGAL水平为(37.86±3.68)μg/L、(10.48±1.57)ng/mL、(36.63±3.57)μg/L,高于病程5~10年组[(28.74±3.25)μg/L、(8.02±1.23)ng/mL、(22.42±2.36)μg/L]及≤5年组[(19.54±2.65)μg/L、(6.73±1.02)ng/mL、(14.49±1.61)μg/L],差异均有统计学意义(P<0.05);尿ZAG、KIM-1和NGAL联合诊断对DN的诊断效能明显高于3项指标单独检测。结论尿ZAG、KIM-1和NGAL联合检测应用于DN诊断,操作简单、敏感度高,能够实现对患者疾病进展的评估及对肾损伤的早期检出,为临床治疗提供参考。

Objective To explore the value of combined detection of urinary zinc-α-2-glycoprotein(ZAG),kidney injury molecule-1(KIM-1)and neutrophil gelatinase-associated lipid transport protein(NGAL)in the diagnosis of DN.Methods Eighty cases of patients with DN admitted to the Affiliated Hospital of Yan’an University from January 2018 to August 2020 were prospectively selected as the observation group.Eighty healthy subjects who received regular physical examinations during the same period served as the control group.The levels of urinary ZAG,KIM-1 and NGAL in patients with different disease progression and different course of disease were detected and compared between the two groups,the diagnostic value of joint detection was analyzed.Results The levels of urinary ZAG,KIM-1 and NGAL in the observation group were(28.25±3.63)μg/L,(7.84±1.25)ng/mL,(25.34±4.75)μg/L,which were higher than those in the control group[(12.49±2.74)μg/L,(4.52±0.56)ng/mL,(7.94±1.36)μg/L],and the differences were statistically significant(P<0.05).The levels of urinary ZAG,KIM-1 and NGAL in renal failure group were(39.33±4.68)μg/L,(10.69±2.54)ng/mL,(45.30±5.75)μg/L,which were higher than those in the clinical proteinuria group[(25.42±3.57)μg/L,(8.43±2.21)ng/mL,(20.48±4.43)μg/L]and microalbuminuria group[(17.65±2.77)μg/L,(6.42±1.02)ng/mL,(15.53±3.22)μg/L],the differences were statistically significant(P<0.05).The levels of urinary ZAG,KIM-1 and NGAL in the disease course≥10 years group were(37.86±3.68)μg/L,(10.48±1.57)ng/mL,(36.63±3.57)μg/L,which were higher than the disease course by 5 to 10 years group[(28.74±3.25)μg/L,(8.02±1.23)ng/mL,(22.42±2.36)μg/L]and≤5 years group[(19.54±2.65)μg/L,(6.73±1.02)ng/mL,(14.49±1.61)μg/L],the differences were statistically significant(P<0.05).The AUC of the combined diagnosis of ZAG,KIM-1 and NGAL was 0.852,95%CI was 0.679~0.893.Conclusion The combined detection of ZAG,KIM-1 and NGAL in urine for the diagnosis of DN is simple and sensitive,which can realize the evaluation of disease progression and early detection of renal injury,and provide reference for clinical treatment.