同型半胱氨酸、胱抑素C及超敏C反应蛋白检测对早期2型糖尿病肾病的诊断价值

Diagnostic value of homocysteine,cystatin C and high-sensitivity C-reactive protein in early type 2 diabetic nephropathy

目的探讨血清同型半胱氨酸(Hcy)、胱抑素C(Cys C)及超敏C反应蛋白(hs-CRP)检测对于早期2型糖尿病肾病的诊断价值。方法选取218例早期2型糖尿病患者,根据尿白蛋白/肌酐比值(UACR)分为正常尿白蛋白组(UACR<30 mg/g,79例)、微量尿白蛋白组(UACR为30~300 mg/g,72例)和大量尿白蛋白组(UACR>300 mg/g,67例);另选取同期体检的70例健康者作为对照组。所有研究对象均行Hcy、Cys C、hs-CRP检测。比较四组Hcy、Cys C和hs-CRP水平,分析糖尿病患者Hcy、Cys C和hs-CRP水平与UACR水平的相关性,比较异常尿白蛋白患者Hcy、Cys C、hs-CRP单独检测与联合检测阳性率。结果正常尿白蛋白组Hcy、Cys C和hs-CRP水平分别为(11.35±1.23)μmol/L、(0.94±0.13)mg/L、(1.85±0.16)mg/L,微量尿白蛋白组Hcy、Cys C和hs-CRP水平分别为(17.87±1.34)μmol/L、(1.91±0.22)mg/L、(8.54±0.49)mg/L,大量尿白蛋白组Hcy、Cys C和hs-CRP水平分别为(26.94±2.28)μmol/L、(2.97±0.39)mg/L、(16.28±1.77)mg/L,对照组Hcy、Cys C和hs-CRP水平分别为(6.49±0.85)μmol/L、(0.47±0.08)mg/L、(0.82±0.11)mg/L。正常尿白蛋白组、微量尿白蛋白组以及大量尿白蛋白组患者的Hcy、Cys C和hs-CRP水平明显高于对照组,大量尿白蛋白组患者的Hcy、Cys C和hs-CRP水平明显高于微量尿白蛋白组以及正常尿白蛋白组,微量尿白蛋白组患者的Hcy、Cys C和hs-CRP水平明显高于正常尿白蛋白组,差异有统计学意义(P<0.05)。Pearson相关性分析结果表明,糖尿病患者Hcy、Cys C和hs-CRP水平与UACR水平均呈正相关(r=0.548、0.591、0.502,P<0.05)。Hcy、Cys C、hs-CRP联合检测对微量尿白蛋白组和大量尿白蛋白组的检测阳性率均高于Hcy、Cys C、hs-CRP单独检测,差异有统计学意义(P<0.05)。结论Hcy、Cys C及hs-CRP检测在早期2型糖尿病肾病的诊断中具有重要应用价值,三项指标联合检测能够进一步提高诊断正确率,为临床治疗提供可靠依据。

Objective To discuss the diagnostic value of homocysteine(Hcy),cystatin C(Cys C)and high-sensitivity C-reactive protein(hs-CRP)in early type 2 diabetic nephropathy.Methods A total of 218 patients with early type 2 diabetes mellitus were selected.According to urinary albumin/creatinine ratio(UACR),they were divided into normal urinary albumin group(UACR<30 mg/g,79 cases),microalbuminuria group(UACR 30-300 mg/g,72 cases)and large urinary albumin group(UACR>300 mg/g,67 cases).Another 70 healthy subjects who underwent physical examination during the same period were selected as the control group.All subjects were tested for Hcy,Cys C and hs-CRP.The levels of Hcy,Cys C and hs-CRP in the four groups were compared,and the correlation of levels of Hcy,Cys C and hs-CRP with level of UACR in diabetic patients was analyzed,and the positive rates of individual and joint detection of Hcy,Cys C and hs-CRP in patients with abnormal urinary albumin were compared.Results The levels of Hcy,Cys C and hs-CRP in normal urinary albumin group were(11.35±1.23)μmol/L,(0.94±0.13)mg/L and(1.85±0.16)mg/L,respectively;the levels of Hcy,Cys C and hs-CRP in microalbumin group were(17.87±1.34)μmol/L,(1.91±0.22)mg/L and(8.54±0.49)mg/L,respectively;the levels of Hcy,Cys C and hs-CRP were(26.94±2.28)μmol/L,(2.97±0.39)mg/L and(16.28±1.77)mg/L,respectively;the levels of Hcy,Cys C and hs-CRP in the control group were(6.49±0.85)μmol/L,(0.47±0.08)mg/L and(0.82±0.11)mg/L,respectively.The levels of Hcy,Cys C and hs-CRP in normal urinary albumin group,microalbuminuria group and large urinary albumin group were significantly higher than those in the control group;the levels of Hcy,Cys C and hs-CRP in the large urinary albumin group were significantly higher than those in the microalbuminuria group and the normal urinary albumin group;the levels of Hcy,Cys C and hs-CRP in the microalbumin group were significantly higher than those in the normal urinary albumin group;the differences were statistically significant(P<0.05).Pearson correlation analysis showed that the levels of Hcy,Cys C and hs-CRP were positively correlated with the level of UACR in diabetic patients(r=0.548,0.591,0.502;P<0.05).The positive rate of joint detection of Hcy,Cys C and hs-CRP was higher than that of individual detection of Hcy,Cys C and hs-CRP in microalbumin group and large urinary albumin group,and the differences were statistically significant(P<0.05).Conclusion The detection of Hcy,Cys C and hs-CRP has important application value in the diagnosis of early type 2 diabetic nephropathy.The joint detection of the three indexes can further improve the diagnostic accuracy and provide a reliable basis for clinical treatment.