血清RBP4联合尿L-FABP在2型糖尿病合并早期肾损伤诊断中的价值

Diagnostic value of serum RBP4 and urinary L-FABP in early renal injury of type 2 diabetes mellitus

目的探究血清视黄醇结合蛋白4(RBP4)联合尿液肝型脂肪酸结合蛋白(L-FABP)在2型糖尿病(T2DM)患者合并早期肾损伤中的诊断价值。方法根据24 h尿白蛋白排泄率(UAER)将2016年5月至2017年11月由本院确诊收治的90例T2DM患者分为T2DM组(无早期肾损伤,46例)及T2DM合并肾损伤组(合并早期肾损伤,44例),另选取同期50例健康体检者为对照组。采用酶联免疫吸附法(ELISA)检测各组患者的血清RBP4、尿L-FABP水平,并检测患者的血尿素氮(BUN)、血清肌酐(Scr)、半胱氨酸蛋白酶抑制剂C(Cys-C)、脂蛋白(a)[Lp(a)]等肾功能指标水平,分析RBP4、L-FABP与各肾功能指标间的相关性,另应用受试者工作特征(ROC)曲线分析RBP4、L-FABP对T2DM合并早期肾损伤的诊断价值。结果T2DM合并肾损伤组患者的血清Scr、BUN、Cys-C、Lp(a)水平均显著高于T2DM组及对照组(均P<0.05),且T2DM组的上述各指标水平均显著高于对照组(均P<0.05);T2DM合并肾损伤组患者的血清RBP4、尿L-FABP水平均显著高于T2DM组及对照组(均P<0.05),且T2DM组的血清RBP4、尿L-FABP水平均显著高于对照组(均P<0.05);T2DM合并肾损伤组患者的血清RBP4、尿L-FABP均与Scr、BUN、Cys-C、Lp(a)水平呈正相关(均P<0.05);ROC曲线分析显示,血清RBP4、尿L-FABP诊断T2DM合并早期肾损伤的截断值分别为59.34 ng/mL、6.12μg·[(g·Cr)]^(-1),曲线下面积(AUC)分别为0.828、0.753,两者联合诊断效能最优,AUC为0.874。结论T2DM合并早期肾损伤患者的血清RBP4、尿L-FABP水平显著上升,两者联合检测有利于T2DM合并早期肾损伤的诊断。

Objective To explore the value of retinol-binding protein 4(RBP4)combined with liver-type fatty acid-binding protein(L-FABP)in patients with type 2 diabetes mellitus(T2DM)with early renal injury.Methods According to the 24 h urinary albumin excretion rate(UAER),90 T2DM patients diagnosed and treated in our hospital from May 2016 to November 2017 were divided into T2DM group(no early renal injury,46 cases)and T2DM combined with renal injury group(combined with early renal injury,44 cases),another 50 healthy people in the same period were selected as the control group.Serum RBP4 and urine L-FABP were detected by enzyme-linked immunosorbent assay(ELISA),blood urea nitrogen(BUN),serum creatine(Scr),Cystatin C(Cys-C),lipoprotein(a)[Lp(a)]and other renal function indexes were detected.The correlation between RBP4,L-FABP and renal function indexes was analyzed,and the diagnostic value of RBP4,L-FABP in T2DM with early renal injury was analyzed by receiver operating characteristic(ROC).Results The serum levels of Scr,BUN,Cys-C and Lp(a)in T2DM group with renal injury were significantly higher than those in T2DM group and control group(all P<0.05),and those in T2DM group were significantly higher than those in control group(all P<0.05).The levels of serum RBP4 and urinary L-FABP in T2DM group with renal injury were significantly higher than those in T2DM group and control group(all P<0.05),and those in T2DM group were significantly higher than those in control group(all P<0.05).Serum RBP4 and urine L-FABP were positively correlated with the levels of Scr,BUN,Cys-C and Lp(a)(all P<0.05);ROC analysis showed that the cutoff values of serum RBP4 and urine L-FABP were 59.34 ng/mL and 6.12μg·[(g·Cr)]^(-1),respectively,and the area under the curve(AUC)was 0.828 and 0.753,respectively.The combined diagnostic efficiency of the two was optimal,AUC was 0.874.Conclusions The serum RBP4 and urine L-FABP increased significantly in T2DM patients with early renal injury,and the combined detection of the two is beneficial to the diagnosis of early renal injury in T2DM patients.