糖脂代谢指标及尿微量白蛋白检测在糖尿病肾病早期诊断中的应用

Application of glucose and lipid metabolism index and urine microalbumin in early detection of diabetic nephropathy

目的探讨糖脂代谢指标及尿微量白蛋白(mALB)检测在糖尿病肾病(DN)早期诊断中的应用。方法选择2020年2月—2022年3月常州市新北区三井人民医院院收治的70例糖尿病患者作为研究对象,根据24 h尿清蛋白排泄率(UAER)将患者分为DN组(36例)和单纯糖尿病组(DM组,34例);另外选择同期30名健康体检者作为对照组。所有受检者采集血样并收集24 h尿液,使用全自动生化分析仪检测三酰甘油(TG),高效液相色谱法检测糖化血红蛋白(HbAlc),采用免疫比浊法检测mALB。比较各组上述指标的差异;绘制受试者工作特征曲线(ROC曲线)并计算ROC曲线下面积(AUC),分析各指标对早期DN的诊断价值。结果DN组HbAlc、TG、mALB水平均明显高于DM组和对照组〔HbAlc:0.095±0.020比0.073±0.017、0.059±0.013,TG(mmol/L):2.51±0.73比1.26±0.46、0.76±0.11,mALB(mg/24 h):53.69±6.78比13.25±3.51、9.25±2.04,均P<0.05〕;HbAlc、TG、mALB联合检测对早期DN诊断的AUC为0.905,95%可信区间(95%CI)为0.357~3.458,准确度、敏感度、特异度分别为92.15%、90.35%、91.07%,均明显高于单项检测。结论HbAlc、TG、mALB对早期DN均有一定诊断价值,联合检测有助于临床及时发现早期肾损伤及判定病情严重程度,为制定治疗方案提供指导意见。

Objective To explore the application of glucose and lipid metabolism indexes and urine microalbumin(mALB)in the early detection of diabetic nephropathy(DN).Methods The 70 patients with diabetes mellitus admitted to Changzhou Xinbei District Sanjing People's Hospital from February 2020 to March 2022 were selected as research subjects,and the patients were divided into DN group(36 cases)and simple diabetes group(DM group,34 cases)according to 24 hour urinary albumin excretion rate(UAER).In addition,30 health examinees in the same period were selected as the control group.The blood samples and urine for 24 hours were collected from all subjects,and triacylglycerol(TG)was detected by automatic biochemical analyzer,glycosylated hemoglobin(HbAlc)was detected by high performance liquid chromatography,and mALB was detected by immune turbidimetry.The differences of the above indicators in each group were compared.The receiver operator characteristic(ROC)curve was drawn,the area under ROC curve(AUC)was calculated,and the diagnostic value of each index for early DN was analyzed.Results The levels of HbAlc,TG and mALB in DN group were higher than those in DM group and control group[HbAlc:0.095±0.020 vs.0.073±0.017,0.059±0.013,TG(mmol/L):2.51±0.73 vs.1.26±0.46,0.76±0.11,mALB(mg/24 h):53.69±6.78 vs.13.25±3.51,9.25±2.04,all P<0.05].The AUC of HbAlc,TG and mALB combined detection for early DN diagnosis was 0.905,and the 95%confidence interval(95%CI)was 0.357-3.458.The accuracy,sensitivity and specificity were 92.15%,90.35%and 91.07%,respectively,which were significantly higher than those of single indexes.Conclusions HbAlc,TG and mALB have certain diagnostic value for early DN.The combined detection is helpful to timely detect early renal injury and determine the severity of the disease,so as to provide guidance for formulating treatment plans.