mAlb联合CysC、HbA1c和uNGAL在2型糖尿病早期肾损伤中的诊断价值

Diagnostic Value of Urinary Microalbumin Combined with Cys C,HbA1c and uNGAL in Early Renal Injury of Type 2 Diabetes Mellitus

目的探讨尿微量白蛋白(mAlb)联合血清胱抑素C(Cys C)、糖化血红蛋白(HbA1c)和尿液中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)在2型糖尿病(T2DM)早期肾损伤中的诊断价值。方法选择2020年8月至2022年8月就诊于镇平县中医院的105例2型糖尿病患者作为研究对象,根据患者是否合并早期肾损伤将其分为肾损伤组和非肾损伤组。对比两组患者尿mAlb、血清Cys C、HbA1c和uNGAL水平。采用Kendall’s tau-b(K)检验分析mAlb、Cys C、HbA1c、uNGAL与T2DM肾损伤的相关性;绘制ROC曲线,分析并比较尿mAlb、血清Cys C、HbA1c、uNGAL单独及联合预测2型糖尿病早期肾损伤的价值。结果肾损伤组的mAlb、Cys C、HbA1c和uNGAL水平均比非肾损伤组高,差异具有统计学意义(P<0.05)。Kendall’s tau-b(K)检验发现,mAlb、Cys C、HbA1c、uNGAL水平与T2DM肾损伤的发生呈正相关,差异具有统计学意义(r=0.669、0.534、0.478、0.569,P<0.05)。Cys C、HbA1c和uNGAL单独及联合预测T2DM早期肾损伤发生的AUC值分别为0.737(95%CI:0.639~0.834)、0.769(95%CI:0.677~0.861)、0.691(95%CI:0.589~0.793)、0.730(95%CI:0.630~0.831)、0.816(95%CI:0.736~0.896);特异度分别为0.793、0.810、0.724、0.759、0.948,灵敏度分别为0.617、0.632、0.598、0.621、0.620;联合预测T2DM早期肾损伤发生的AUC分别高于Cys C、HbA1c和uNGAL单独检测(Z=8.632、3.152、5.324、5.386,P=0.000、0.012、0.000、0.000、0.000)。结论尿mAlb、血清Cys C、HbA1c和uNGAL在T2DM早期肾损伤患者中表达升高,上述指标与T2DM早期肾损伤的发生呈正相关,通过联合应用上述指标可提高疾病的诊断效果。

Objective To investigate the diagnostic value of urinary microalbumin(mAlb)combined with serum cystatin(CysC),glycosylated hemoglobin(HbA1c)and neutrophil gelatinase-associated lipid carrier protein(uNGAL)in early renal injury in type 2 diabetes mellitus(T2DM).Methods A total of 105 patients with type 2 diabetes mellitus admitted to Zhenping Hospital of Traditional Chinese Medicine from August 2020 to August 2022 were selected as study subjects and divided into renal injury group and non renal injury group according to whether the patients had early kidney injury.Urinary microalbumin(mAlb),Cys C,HbA1c and uNGAL levels were compared between the two groups.Kendall’s tau-b(K)test was used to analyze the correlation between mAlb,Cys C,HbA1c,uNGAL and T2DM renal injury.Draw ROC curve,analyze and compare the value of urinary mAlb,serum Cys C,HbA1c,uNGAL alone and jointly in predicting early renal injury in type 2 diabetes.Results The levels of mAlb,Cys C,HbA1c and uNGAL in renal injury group were significantly higher than those in non-renal injury group,the difference was statistically significant(P<0.05).The AUC values for predicting early renal injury in T2DM using ys C,HbA1c,and uNGAL alone and in combination were 0.737(95%CI:0.639~0.834),0.769(95%CI:0.777~0.861),0.691(95%CI:0.589~0.793),0.730(95%CI:0.630~0.831),0.816(95%CI:0.736~0.896);The specificity was 0.793,0.810,0.724,0.759,0.948,and the sensitivity was 0.617,0.632,0.598,0.621,0.620,respectively.The AUC of the combined prediction of early renal injury in T2DM was higher than that of Cys C,HbA1c and uNGAL alone(Z=8.632,3.152,5.324,5.386,P=0.000,0.012,0.000,0.000,0.000,respectively).Conclusion Urinary microalbumin combined with CysC,HbA1c and uNGAL are all expressed at abnormally high levels in patients with early T2DM kidney injury,and the above indexes are positively correlated with the occurrence of early T2DM kidney injury.The combined application of the above indicators can improve the diagnostic effectiveness of diseases,which has further promotion significance and application value.