血清C肽与糖化血红蛋白诊断老年糖尿病肾病的临床价值

Clinical Value of Serum C-peptide and Glycated Hemoglobin in Diagnos⁃ing Diabetic Nephropathy in the Elderly

目的探讨血清C肽与糖化血红蛋白(HbA1c)在诊断老年糖尿病肾病(diabetic nephropathy,DN)中的临床应用价值。方法回顾性选取2020年11月—2021年12月福建省老年医院收治的60例老年糖尿病(diabe-tes mellitus,DM)患者(设为观察组)和在本院进行健康体检的60名健康老年人(设为对照组)。按照《糖尿病肾病防治专家共识(2014年版)》中糖尿病肾病(DN)的诊断标准,将观察组分为单纯DM组(n=33)和DN组(n=27)。对患者HbA1c、血清C肽水平进行检测。分别对照组和观察组、单纯DM组和DN组的HbA1c、血清C肽水平予以比较,建立风险评估模型,经受试者工作特征曲线(ROC)分析HbA1c联合血清C肽评估老年DN的诊断效能。结果与对照组相比较,观察组HbA1c水平较高,血清C肽水平较低,差异有统计学意义(P<0.05)。DN组HbA1c、血清C肽水平水平明显高于单纯DM组,差异有统计学意义(P<0.05)。由ROC曲线分析,采用HbA1c、血清C肽联合检测DN的AUC值最高,为0.978,且灵敏度、特异度分别为96.66%、86.66%。结论老年DN患者的HbA1c水平健康较人群明显升高,血清C肽水平明显降低;与单纯DM患者相比较,DN患者的HbA1c、血清C肽水平较高。HbA1c、血清C肽指标联合检测在诊断老年DN患者方面具有较高的临床应用价值。

Objective To investigate the clinical application value of serum C-peptide and glycated hemoglobin(HbA1c)in the diagnosis of diabetic nephropathy(DN)in the elderly.Methods Sixty cases of elderly patients with dia-betes mellitus(DM)admitted to Fujian Provincial Geriatric Hospital from November 2020 to December 2021(set as the observation group)and 60 healthy elderly people who underwent health check-ups in our hospital(set as the con-trol group)were retrospectively selected.According to the diagnostic criteria of diabetic nephropathy(DN)in the Ex-pert Consensus on the Prevention and Treatment of Diabetic Nephropathy(2014 version),the observation group was di-vided into the DM-only group(n=33)and the DN group(n=27).The HbA1c and serum C-peptide levels of the pa-tients were tested.The HbA1c and serum C-peptide levels were compared in the control and observation groups,the DM-only group and the DN group,respectively,and a risk assessment model was established to analyze the diagnostic efficacy of HbA1c combined with serum C-peptide in assessing elderly DN by subject operating characteristic curve(ROC).Results Compared with the control group,the observation group had higher HbA1c levels and lower serum C-peptide levels,and the difference was statistically significant(P<0.05).The levels of HbA1c and serum C-peptide in the DN group were significantly higher than those in the simple DM group,and the difference was statistically signifi-cant(P<0.05).According to receiver operating characteristic analysis,the AUC value of DN detected by HbA1c and serum C-peptide is the highest,which is 0.978,and the sensitivity and specificity are 96.66%and 86.66%,respec-tively.Conclusion Elderly patients with DN have significantly higher HbA1c levels and significantly lower serum C-peptide levels than the population.Compared with patients with DM alone,DN patients had higher HbA1c and serum C-peptide levels.The combined test of HbA1c and serum C-peptide index has high clinical application value in diag-nosing elderly DN patients.