随机尿蛋白、尿蛋白/肌酐比值及尿微量白蛋白/肌酐比值在早期糖尿病肾病中应用价值

Application value of random urine protein,urinary albumin/urinary creatinine ratio and urine microalbumine creatinine ratio in early diabetic nephropathy

目的探讨随机尿蛋白、尿蛋白/肌酐比值(ACR)及尿微量白蛋白/肌酐比值(UACR)在早期糖尿病肾病(EDN)中的应用价值。方法将四川大学华西医院自2019年5月至2020年9月收治的248例EDN患者纳入EDN组;将同期收治的188例单纯糖尿病患者纳入糖尿病组;将同期征集的102例健康体检者纳入健康对照组。比较健康对照组、糖尿病组、EDN组的随机尿蛋白、ACR、UACR、血清胱抑素C(CysC)、肾小球滤过率(eGFR)水平,比较EDN组、糖尿病组的尿蛋白定性及颗粒管型检测结果,采用Pearson法分析EDN组随机尿蛋白、ACR、UACR与肾功能指标的相关性,采用受试者工作特征(ROC)曲线和曲线下面积(AUC)评估随机尿蛋白、ACR、UACR及三者联合检测对EDN的诊断价值。结果EDN组的随机尿蛋白、ACR、UACR水平均高于糖尿病组和健康对照组,糖尿病组的随机尿蛋白、ACR、UACR水平均高于健康对照组,差异有统计学意义(P<0.05)。EDN组的CysC水平高于糖尿病组和健康对照组,糖尿病组的CysC水平高于健康对照组,差异有统计学意义(P<0.05);EDN组的eGFR水平低于糖尿病组和健康对照组,糖尿病组的eGFR水平低于健康对照组,差异有统计学意义(P<0.05)。EDN组的尿蛋白阳性率和有颗粒管型比例高于糖尿病组,差异有统计学意义(P<0.05)。EDN患者随机尿蛋白、ACR、UACR与CysC均呈正相关,与eGFR均呈负相关(P<0.05)。随机尿蛋白、ACR、UACR三者联合检测诊断EDN的AUC为0.962(95%可信区间0.945~0.979),高于随机尿蛋白、ACR、UACR的单一检测(P<0.05)。结论随机尿蛋白、ACR、UACR对EDN具有较好的诊断价值,三者联合检测的诊断效能更高。

Objective To investigate the clinical value of random urine protein,urinary albumin/urinary creatinine ratio(ACR)and urine microalbumine creatinine ratio(UACR)in early diabetic nephropathy(EDN).Methods A total of 248 patients with EDN admitted to West China Hospital of Sichuan University from May 2019 to September 2020 were included in the EDN group.A total of 188 patients with simple diabetes admitted during the same period were included in the diabetes group.A total of 102 healthy persons enrolled in the same period were included in the healthy control group.The levels of random urine protein,ACR,UACR,serum Cystatin C(CysC)and estimated glomerular filtration rate(eGFR)in healthy control group,diabetes group and EDN group were compared.The qualitative and granular tube detection results of urine protein in EDN group and diabetes group were compared.Pearson method was used to analyze the correlation between random urine protein,ACR,UACR and renal function indexes in EDN group.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the diagnostic value of random urine protein,ACR,UACR and their combined detection for EDN.Results The levels of random urine protein,ACR and UACR in EDN group were higher than those in diabetes group and healthy control group,and the levels of random urine protein,ACR and UACR in diabetes group were higher than those in healthy control group,with statistical significance(P<0.05).The level of CysC in EDN group was higher than that in diabetes group and healthy control group,and that in diabetes group was higher than that in healthy control group,the difference was statistically significant(P<0.05).The eGFR level of EDN group was lower than that of diabetes group and healthy control group,and that of diabetes group was lower than that of healthy control group,the difference was statistically significant(P<0.05).The positive rate of urine protein and the proportion of granular tube type in EDN group were higher than those in diabetes group,and the difference was statistically significant(P<0.05).In EDN patients,random urine protein,ACR,UACR were positively correlated with CysC,and negatively correlated with eGFR(P<0.05).The AUC of the combined detection of random urine protein,ACR and UACR for the diagnosis of EDN was 0.962(95%confidence interval 0.945-0.979),which was higher than that of single detection of random urine protein,ACR and UACR(P<0.05).Conclusion Random urine protein,ACR and UACR have better diagnostic value for EDN,and their combined detection has higher diagnostic efficiency.