红细胞分布宽度、C反应蛋白与白蛋白比值、尿白蛋白与肌酐比值联合检测在2型糖尿病并发症预测中的应用

Application of combined detection of red blood cell distribution width,ratio of C-reactive protein to albumin and albumin-to-creatinine ratio in predicting complications of type 2 diabetes

目的 探讨红细胞分布宽度(RDW)、C反应蛋白与白蛋白比值(CAR)、尿白蛋白与肌酐比值(UACR)联合检测在2型糖尿病(T2DM)并发症预测中的应用价值。方法 选取T2DM并发症患者与T2DM无并发症患者各104例作为研究对象,分别纳入观察组与对照组。收集2组病历资料,比较2组一般资料、RDW、CAR、UACR水平差异,并通过受试者工作特征(ROC)曲线分析RDW、CAR、UACR单用与3者联合应用对T2DM并发症的预测效能。结果 与对照组比较,观察组的餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、RDW、CAR、UACR水平更高,高密度脂蛋白胆固醇(HDL-C)水平更低,差异有统计学意义(P<0.05)。相关性分析结果显示,RDW与2 hPG、HbAlc、TC、LDL-C均呈正相关,与HDL-C呈负相关;CAR与2 hPG、HbAlc、TC、LDL-C均呈正相关,与HDL-C呈负相关;UACR与2 hPG、HbAlc、TC、LDL-C均呈正相关,与HDL-C呈负相关。Logistic回归分析显示,RDW、CAR、UACR均是T2DM患者并发糖尿病视网膜病变(DR)、糖尿病肾脏疾病(DKD)、糖尿病周围神经病变(DPN)、冠心病(CAD)的影响因素(P<0.05)。ROC曲线分析显示,RDW、CAR、UACR单独检测及3项联合应用预测T2DM并发症的AUC分别为0.753、0.858、0.885、0.915。与RDW、CAR、UACR单独检测比较,3项联合应用对T2DM并发症的预测效能更高(Z=3.221、2.605、2.334,P<0.05)。结论 RDW、CAR、UACR水平升高与T2DM患者并发症的发生密切相关,RDW、CAR、UACR单独应用对T2DM并发症均有一定预测价值,但3项联合应用对T2DM并发症的预测效能更高。

Objective To explore the value of combined detection of red blood cell distribution width(RDW),C-reactive protein-to-albumin ratio(CAR)and albumin-to-creatinine ratio(UACR)in the prediction of complications of type 2 diabetes mellitus(T2DM).Methods A total of 104 T2DM patients with complications and 104 T2DM patients without complications were selected as study subjects,and were included in observation group and control group respectively.The differences in general data,RDW,CAR and UACR levels between the two groups were compared.The predictive efficacy of RDW,CAR and UACR alone or their combination for T2DM complications was analyzed by receiver operating characteristic(ROC)curve.Results Compared with the control group,the levels of 2-hour postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbAlc),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),RDW,CAR and UACR in the observation group were higher,and the level of HDL-C was lower(P<0.05).Correlation analysis showed that RDW was positively correlated with 2 hPG, HbAlc, TC, LDL-C, and negativelycorrelated with HDL-C;CAR was positively correlated with 2 hPG, HbAlc, TC, LDL-C and negatively correlated with HDL-C;UACR was positively correlated with PPG, HbAlc, TC, LDL-C and negatively correlated with HDL-C. Logistic regression analysis showed that RDW, CAR and UACR were the influencing factors of T2DM patients complicated with diabetic retinopathy (DR), diabetic kidney disease (DKD), diabetic peripheral neuropathy (DPN), coronary artery disease (CAD) ( P <0.05) . ROC curve analysis showed that the area under curve ( AUC ) of RDW, CAR and UACR alone and their combination were 0.753, 0.858, 0.885 and 0.915, respectively. Compared with RDW, CAR and UACR alone, the combination of the three indicators had higher predictive efficacy for T2DM complications ( Z =3.221, 2.605 and 2.334, P <0.05). Conclusion The increased levels of RDW, CAR and UACR are closely related to the occurrence of complications in patients with T2DM. Detection of RDW, CAR or UACR alone has a certain predictive value for the complications of T2DM, but their combination has a higher predictive efficacy.