血清和尿CN1在老年糖尿病肾病中的诊断价值分析

Diagnostic value of serum and urine CN1 foRdiabetic nephropathy in elderly patients

目的研究血清和尿中肌肽二肽酶1(CN1)对老年糖尿病肾病(DN)的诊断价值。方法选取我院诊治的168例T2DM病人,根据尿白蛋白/肌酐比值(UACR),分为对照组(UACR<30 mg/g,n=46)和DN组(UACR≥30 mg/g,n=122)。比较2组血清和尿中CN1水平及临床生化指标,并进行相关性分析。采用多因素Logistic回归分析影响DN发生的因素。采用ROC曲线分析各指标对DN的诊断价值。结果与对照组比较,DN组估计肾小球滤过率(eGFR)较低,而UACR、血肌酐、血BUN、血UA、胱抑素C、血清和尿CN1水平明显较高,差异具有统计学意义(均P<0.05)。血清、尿CN1水平与UACR、血肌酐、血BUN水平呈显著正相关,与eGFR呈显著负相关(均P<0.05)。eGFR、胱抑素C、血清CN1和尿CN1是DN的独立影响因素。ROC曲线分析显示,eGFR、胱抑素C、血清CN1、尿CN1及联合检测对DN诊断的AUC分别为0.851、0.760、0.838、0.849、0.944,联合检测的AUC显著优于单项指标(P<0.05)。结论DKD病人血清和尿CN1水平升高,是影响老年T2DM病人DN发生的独立危险因素,eGFR、胱抑素C、血清和尿CN1联合检测对DN具有较高的诊断价值。

Objective To study the clinical value of serum and urine carnosine dipeptidase 1(CN1)in the diagnosis of diabetic nephropathy(DN)in the elderly.Methods A total of 168 elderly patients with type 2 diabetes mellitus(T2DM)in ouRhospital were enrolled and divided into control group(n=46)and DN group(n=122)according to whetheRthe level of urinary albumin creatinine ratio(UACR)was≥30 mg/g.The serum and urine levels of CN1 and the serum levels of the clinical biochemical indicators were compared between the two groups,and were analyzed by Pearson correlation.Multivariate Logistic regression analysis was used to analyze the influencing factors of DN.The diagnostic value of each index foRDN was analyzed by the receiveRoperating characteristic(ROC)curve.Results Compared with the control group,the level of estimated glomerulaRfiltration rate(eGFR)was lower,while the UACR,the serum levels of creatinine,urea nitrogen,uric acid and cystatin C,and the serum and urine levels of CN1 were significantly higheRin the DN group(all P<0.05).Serum and urine levels of CN1 were significantly positively correlated with UACR,serum levels of creatinine and urea nitrogen,and significantly negatively correlated with eGFR(all P<0.05).The levels of eGFR,cystatin C,serum and urine CN1 were the independent influencing factors of DN.The area undeRthe ROC curve(AUC)of eGFR,cystatin C,serum CN1,urine CN1 and combined detection foRthe diagnosis of DN were 0.851,0.760,0.838,0.849 and 0.944,respectively.The AUC of combined detection was significantly betteRthan that of single indicatoR(P<0.05).Conclusions The increased serum and urinary levels of CN1 in diabetic patients are independent risk factors affecting the occurrence of DN in the elderly.Combined detection of eGFR,cystatin C,serum and urinary CN1 has high diagnostic value foRDN.