皮肤电导率在早期糖尿病肾病筛查中的应用价值

Value of electrochemical skin conductance in screening early diabetic kidney disease

目的探讨皮肤电导率(ESC)在早期糖尿病肾病筛查中的应用价值。方法选取2022年10月至2023年2月于安徽医科大学第二附属医院分泌科住院的176例2型糖尿病患者,根据尿白蛋白/肌酐比值(UACR)和肾小球滤过率(eGFR)将其分为两组,糖尿病肾病组(DKD组,n=68)和糖尿病非肾病组(non-DKD组,n=108),所有患者均完善SUDOSCAN仪检测,获得双手、双足ESC(HESC、FESC),肾病风险分数(SUDOSCAN-DN),采用Spearman相关性分析UACR与SUDOSCAN各指标的关系。采用受试者工作特征(ROC)曲线判断SUDOSCAN各指标对糖尿病肾病的诊断效能。结果与non-DKD组相比,DKD组年龄较大,病程较长,收缩压较高,三酰甘油(TG)、血尿酸及肌酐、促甲状腺激素(TSH)水平较高,HbA1c水平偏低,HESC、FESC、SUDOSCAN-DN值均较低,差异有统计学意义(P<0.05);Spearman相关分析显示,UACR与TC、LDL-C、血肌酐、TSH呈正相关(r值分别为0.202、0.207、0.378、0.174,P<0.05),与eGFR、HESC、FESC、SUDOSCAN-DN呈负相关(r值分别为-0.300、-0.273、-0.861、-0.287,P<0.05);多元线性回归分析结果显示,FESC、SUDOSCAN-DN、病程是UACR的独立危险因素(P<0.05);以UACR为糖尿病肾病诊断金标准,分别以SUDOSCAN-DN、FESC、SUDOSCAN-DN+FESC构建ROC曲线,SUDOSCAN-DN+FESC诊断的灵敏度为60.1%,特异度为79.8%,ROC曲线下面积为0.741,95%CI:0.664~0.819(P<0.05)。结论SUDOSCAN指标与UACR显著相关,对筛查早期糖尿病肾病有一定价值。

Objective To investigate the diagnostic value of electrochemical skin conductance(ESC)in screening of early diabetic kidney disease.Methods The clinical data of 176 patients with type 2 diabetes admitted to the Department of Endocrinology,the Second Affiliated Hospital of Anhui Medical University from October 2022 to February 2023 were analyzed.The patients divided into two groups according to urinary albumin to creatinine ratio(UACR)and estimated glomerular filtration(eGFR),namely,diabetic kidney disease group(DKD group,n=68)and non-diabetic kidney disease group(non-DKD group,n=108).All patients were tested by SUDOSCAN instrument to obtain ESC(HESC,FESC)of both hands and feet,as well as the diabetic kidney disease score(Sudoscan-DN).The link between UACR and SUDOSCAN parameters were compared using Spearman’s correlation analysis,and the diagnostic efficacy of SUDOSCAN on diabetic kidney disease was determined by ROC curve.Results Compared with the non-DKD group,the DKD group was older,the duration was longer,the systolic blood pressure was higher,the TG,serum uric acid and creatinine,TSH levels were higher,the HbA1c was lower,the HESC,FESC and SUDOSCAN-DN values were lower,and the differences were statistically significant(P<0.05).Spearman correlation analysis showed that UACR was significantly positively correlated with TC,LDL-C,serum creatinine and TSH(r value was respectively 0.202、0.207、0.378、0.174,P<0.05),and negatively correlated with eGFR,HESC,FESC and SUDOSCAN-DN(r value was respectively-0.300、-0.273、-0.861、-0.287,P<0.05).Multiple linear regression analysis showed that FESC,SUDOSCAN-DN and disease duration were independent risk factors for UACR(P<0.05).UACR used as the diagnostic criteria for diabetic nephropathy,SUDOSCAN-DN,FESC and SUDOSCAN-DN+FESC used to perform ROC curve,respectively,the sensitivity and specificity of SUDOSCAN-DN+FESC diagnosis was 60.1%,79.8%respectively,the area under ROC curve was 0.741 and 95%confidence interval(0.664~0.819)(P<0.05).Conclusion SUDOSCAN parameters are markedly associated with UACR,which can be potential predictors for early type2 diabetic nephropathy.