血清HbA1C、ACR与2型糖尿病早期肾脏损害的关系

Relationship between serum HbA1C,ACR and early kidney damage in type 2 diabetes mellitus

目的探讨糖化血红蛋白A1c(HbA1c)、尿微量白蛋白(U⁃malb)/尿肌酐(Cr)比值(ACR)与2型糖尿病(T2DM)及早期糖尿病肾脏疾病(EDN)的关系。方法选取本院2018年4月至2021年8月期间确诊的46例EDN患者为研究对象(EDN组),同期选取本院住院治疗的49例单纯T2DM患者作为T2DM组。采用全自动糖化血红蛋白仪检测血清HbA1C水平,采用酶联免疫吸附(ELISA)法检测血清胱抑素C(CysC)、U⁃malb水平,采用全自动生化分析仪检测血尿素氮(BUN)、尿Cr水平,ACR=U⁃malb/Cr,采用校正eMDRD方程计算肾小球滤过率(GFR);收集受试者空腹血糖(FPG)、餐后2h血糖(2hPG)等一般资料;Pearson法分析EDN患者血清HbA1C、ACR水平与各指标的相关性;采用受试者工作特征曲线(ROC曲线)分析HbA1C、ACR对EDN的诊断价值。结果EDN组HbA1C、ACR、CysC、FPG、2hPG水平及病程高于T2DM组,GFR水平低于T2DM组,差异有统计学意义(P<0.05)。EDN患者HbA1C与ACR呈正相关(r=0.530,P<0.05),且HbA1C、ACR与病程、FPG、2hPG、CysC呈正相关(P<0.05),与GFR呈负相关(P<0.05),与BUN无明显相关性(P>0.05)。HbA1C、ACR单独及二者联合诊断EDN的曲线下面积(AUC)分别为0.850、0.898、0.935,其中HbA1C、ACR单独诊断AUC均小于联合诊断AUC(Z=1.876、2.595,P<0.05),特异度分别为0.63、0.80、0.75,敏感度分别为0.97、0.84、0.99。结论HbA1C、ACR均与T2DM、EDN有关,二者联合检测可作为诊断EDN的辅助指标。

Objective To investigate the relationship between glycosylated hemoglobin A1c(HbA1c),urinary microalbumin(U⁃malb)/creatinine(Cr)ratio(ACR),type 2 diabetes mellitus(T2DM)and early diabetic nephropathy(EDN).Methods A total of 46 EDN patients diagnosed in this hospital from April 2018 to August 2021 were selected as the research object(EDN group),49 patients with simple T2DM who were hospitalized in our hospital during the same period were selected as the T2DM group.Automatic glycosylated hemoglobin analyzer was used to detect the serum HbA1C level,enzyme⁃linked immunosorbent(ELISA)method was used to detect the serum cystatin C(CysC)and U⁃malb levels,automatic biochemical analyzer was used to detect blood urea nitrogen(BUN)and urine Cr levels,ACR=U⁃malb/Cr,the corrected eMDRD equation was used to calculate the glomerular filtration rate(GFR).The subjects'􀆳fasting blood glucose(FPG),2h postprandial blood glucose(2hPG)and other general data were collected;Pearson method was used to analyze the correlation between serum HbA1C and ACR levels in EDN patients with various indicators.The receiver operator characteristic curve(ROC curve)was used to analyze the diagnostic value of HbA1C and ACR for EDN.Results The levels of HbA1c,ACR,CysC,FPG,2hPG and course of disease in the EDN group were higher than those in the T2DM group,and the level of GFR was lower than that in the T2DM group,the difference was statistically significant(P<0.05).In EDN patients,HbA1C was positively correlated with ACR(r=0.530,P<0.05),and HbA1C and ACR were positively correlated with disease duration,FPG,2hPG,and CysC(P<0.05),and negatively correlated with GFR(P<0.05).There was no significant correlation with BUN(P>0.05).The area under the curve(AUC)of HbA1C,ACR alone and the combined diagnosis of EDN was 0.850,0.898,and 0.935,respectively,the AUC of HbA1C and ACR alone was less than the AUC of combined diagnosis(Z=1.876,2.595,P<0.05),the specificity was 0.63,0.80,and 0.75,and the sensitivity was 0.97,0.84,and 0.99,respectively.Conclusion HbA1C and ACR are both related to T2DM and EDN,and the combined detection of the two can be used as an auxiliary indicator for the diagnosis of EDN.