糖尿病早期肾功能损害诊断中行HbA1c联合微量清蛋白和尿液微量清蛋白与肌酐比值检测的临床分析

Clinical analysis of early renal impairment diagnosis of diabetes mellitus HbA 1c combined with microalbumin and urine microalbumin to creatinine ratio detection

目的探讨糖尿病早期肾功能损害诊断中行糖化血红蛋白(HbA1c)联合微量清蛋白和尿液微量清蛋白与肌酐比值(ACR)检测的效果。方法选择2021年1月至2022年12月糖尿病肾病患者94例为观察组,并将观察组患者分为早期糖尿病肾病组(n=61例)和显性糖尿病肾病组(n=33例);选择同期健康体检者67例为对照组。采用伯乐D10测定各组HbA1c水平;采用博士泰TD240测定微量清蛋白和ACR水平,比较各组HbA1c、微量清蛋白及ACR表达水平;绘制受试者工作特征(ROC)曲线,分析HbA1c、微量清蛋白及ACR在糖尿病早期肾功能损害中的诊断效能。结果观察组糖尿病肾病患者HbA1c、微量清蛋白及ACR水平高于对照组健康体检者,差异有统计学意义(P<0.05);显性糖尿病肾病组患者HbA1c、微量清蛋白及ACR水平高于早期糖尿病肾病组患者(P<0.05);ROC曲线结果表明:HbA1c、微量清蛋白及ACR联合检测在糖尿病早期肾功能损害中的灵敏度高于单一检测指标,差异有统计学意义(P<0.05);特异度低于单一检测指标,差异有统计学意义(P<0.05)。结论HbA1c、微量清蛋白及ACR在糖尿病早期肾功能损害中表达异常,其表达水平能反映患者疾病严重程度,三种指标联合测定能提高患者诊断效能,可指导临床诊疗。

Objective To investigate the effect of glycosylated hemoglobin(HbA1c)combined with microalbumin and urine microalbumin to creatinine ratio(ACR)detection in the diagnosis of early diabetic renal impairment.Methods Ninety four patients with diabetic nephropathy in January 2021 and December 2022 were selected as the observation group,and the observation group was divided into early diabetic nephropathy(n=61)and overt diabetic nephropathy(n=33);67 patients in the same period were selected as the control group.HbA1c levels by Bole D10;microalbumin and ACR levels by TD240 to compare the expression levels of HbA1c,microalbumin and ACR;ROC curves were drawn to analyze the diagnostic efficacy of HbA1c,microalbumin and ACR in the early renal impairment of diabetes.Results HbA1c,microalbumin and ACR levels in diabetic nephropathy group were higher than those in control group,and the differences were statistically significant(P<0.05);HbA1c,microalbumin and ACR in overt diabetic nephropathy group,and the differences were statistically significant(P<0.05);ROC curve results showed that the sensitivity of HbA1c,microalbumin and ACR was higher than single detection index,and the differences were statistically significant(P<0.05);specificity was lower than single detection index,and the differences were statistically significant(P<0.05).Conclusion HbA1c,microalbumin and ACR are abnormally expressed in the early renal impairment of diabetes,and their expression level can reflect the severity of the disease in patients.The combination of the measurement of the three indexes can improve the diagnostic efficiency of patients and guide the clinical diagnosis and treatment.