尿U-HBP、NGAL、U-NIT对糖尿病合并无症状性菌尿患者的诊断及疗效预测价值

Diagnostic and therapeutic predictive value of urine U-HBP,NGAL,U-NIT in diabetic patients with asymptomatic bacteriuria

目的:探讨尿肝素结合蛋白(urinary heparin-binding protein,U-HBP)、中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)、尿亚硝酸盐(urinary nitrite,U-NIT)诊断糖尿病合并无症状性菌尿(asymptomatic bacteriuria,ABU)价值及对疗效的影响。方法:选取2017年1月至2020年10月诸城市人民医院和解放军总医院第四医学中心收治的98例糖尿病合并ABU患者(ABU组)、98例单纯糖尿病患者(糖尿病组)及90例健康体检者(对照组),比较各组基线资料、尿U-HBP、NGAL、U-NIT阳性率,应用多因素logistic回归方程分析ABU的相关影响因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线及ROC下面积(area under the curve,AUC)分析各指标的诊断价值,应用Spearman分析各指标与疗效相关性。结果:ABU组U-HBP、NG AL及U-NIT阳性率高于糖尿病组、对照组(P<0.05);多因素logistic回归方程分析结果显示,U-HBP、NGAL、U-NIT阳性均与ABU相关(均P<0.05);U-HBP、NGAL、U-NIT阳性诊断ABU的AUC依次为0.837、0.815、0.877,联合诊断的AUC达0.953;无效患者的U-HBP和NGAL水平最高,其次为有效患者,显效患者最低;显效患者U-NIT阳性率低于有效、无效患者(P<0.05),有效、无效患者的U-NIT阳性率差异无统计学意义(P>0.05);Spearman进行相关性分析显示,U-HBP、NGAL与疗效呈负相关(P<0.05),U-NIT与疗效无相关性(P>0.05)。结论:U-HBP、NGAL、U-NIT均可有效诊断糖尿病合并ABU,且对疗效具有一定预测价值,对临床诊治具有指导价值。

Objective:To investigate the role of urinary heparin-binding protein(U-HBP),the neutrophil gelatinaseassociated lipocalin(NGAL),and the urinary nitrite(U-NIT)in the diagnosis of diabetes with asymptomatic bacteriuria(ABU)and its effect on curative effect.Methods:Ninety-eight patients with diabetes and ABU(ABU group),98 patients with simple diabetes(diabetes group)and 90 healthy persons(control group)who were admitted to the Fourth Medical Center of Chinese PLA General Hospital and Zhucheng People’s Hospital from January 2017 to October 2020 were selected.The baseline data,positive rate of U-HBP,NGAL,and U-NIT were compared.Multiple logistic regression was used to analyze the related influencing factors of ABU,receiver operating characteristic curve(ROC)and area under the ROC curve(AUC)were used to analyze the diagnostic value of each index,and Spearman’s were used to analyze the correlation between each index and curative effect.Results:The positive rates of U-HBP,NGAL and U-NIT in the ABU group were higher than those in the diabetes group and the control group(P<0.05).Multivariate logistic regression analysis showed that the positive results of U-HBP,NGAL,and U-NIT were all related to ABU(P<0.05).U-HBP,NGAL,U-NIT positive diagnosis of ABU AUC were 0.837,0.815,0.877,and the combined diagnosis AUC reached 0.953.The U-HBP and NGAL level were higher in the invalid patients,then in the valid patients,the last were in the markedly effective patients;the positive rate of U-NIT in markedly effective patients is lower than that of effective and ineffective patients(P<0.05),there was no statistically significant difference in the positive rate of U-NIT between effective and ineffective patients(P>0.05);Spearman’s correlation analysis showed that U-HBP and NGAL were negatively correlated with the curative effect(P<0.05),and U-NIT was not correlated with the curative effect(P>0.05).Conclusion:U-HBP,NGAL,U-NIT can effectively diagnose diabetes with ABU,and have a certain predictive value for the therapeutic effect,and have guiding value for clinical diagnosis and treatment.