糖化血红蛋白与尿微量白蛋白联合检测在老年早期糖尿病肾病诊断中的应用

Application of combined detection of glycosylated hemoglobin and urinary microalbumin in diagnosis of elderly early diabetes nephropathy

目的探讨糖化血红蛋白(HbA1c)与尿微量白蛋白(UMA)联合检测在老年早期糖尿病肾病诊断中的应用价值。方法选择2021年1月—2023年6月在钢城区人民医院就诊的100例2型糖尿病(T2DM)伴肾损伤患者和100例单纯T2DM患者作为研究对象,分别纳入肾损伤组和单纯糖尿病组,另外选择100例健康体检者作为对照组。检测各组受检者的血尿素氮(BUN)、血肌酐(SCr)、HbA1c、UMA、尿肌酐(UCr),计算尿微量白蛋白/肌酐比值(ACR),比较各组上述指标水平差异。对肾损伤患者给予降血糖药物、贝那普利治疗,比较治疗前后的指标水平。结果肾损伤组、单纯糖尿病组的BUN、SCr、HbA1c水平均明显高于对照组[BUN(mmol/L):8.38±1.73、8.04±1.56比5.21±1.20;SCr(μmol/L):94.57±15.20、92.03±14.45比61.74±7.95;HbA1c:0.079±0.013、0.077±0.013比0.050±0.008;均P<0.05],但肾损伤组与单纯糖尿病组的BUN、SCr、HbA1c水平差异均无统计学意义(均P>0.05)。肾损伤组的UMA、ACR水平均明显高于单纯糖尿病组和对照组[UMA(mg/L):41.57±9.20比29.03±5.62、18.74±2.95;ACR(g/mol):32.95±5.63比25.89±4.54、17.31±3.28;均P<0.05],且单纯糖尿病组的UMA、ACR水平均明显高于对照组(均P<0.05)。治疗后肾损伤患者的BUN、SCr、HbA1c、UMA、ACR水平均较治疗前明显降低[BUN(mmol/L):8.38±1.73比6.29±1.32;SCr(μmol/L):94.57±15.20比74.31±10.08;HbA1c:0.079±0.013比0.064±0.011;UMA(mg/L):41.57±9.20比29.74±7.69;ACR(g/mol):32.95±5.63比26.19±4.37,均P<0.05]。结论HbA1c、UMA、ACR水平在2型糖尿病患者中均明显升高,尤其是UMA和ACR能灵敏反映T2DM患者肾损伤,可作为早期诊断的辅助诊断指标,对T2DM肾损伤的治疗效果予以评价。

Objective To explore the application value of combined detection of glycosylated hemoglobin(HbA1c)and urinary microalbumin(UMA)in diagnosis of elderly early diabetes nephropathy.Methods The 100 patients with type 2 diabetes mellitus(T2DM)accompanied with kidney injury and 100 patients with T2DM who were treated in Gangcheng District People's Hospital from January 2021 to June 2023 were selected as research objects and respectively included in kidney injury group and ssimple diabetes group,and 100 healthy people were selected as control group.The levels of blood urea nitrogen(BUN),serum creatinine(SCr),HbA1c,UMA and urinary creatinine(UCr)of each group were detected,the urinary microalbumin/creatinine ratio(ACR)was calculated,and the differences in the levels of above indicators among the groups were compared.The patients with T2DM combined with renal injury were treated with hypoglycemic drugs and benazepril,and the levels of above indexes in patients before and after treatment were compared.Results The levels of BUN,SCr and HbA1c in renal injury group and simple diabetes group were significantly higher than those in control group[BUN(mmol/L):8.38±1.73,8.04±1.56 vs.5.21±1.20;SCr(μmol/L):94.57±15.20,92.03±14.45 vs.61.74±7.95;HbA1c:0.079±0.013,0.077±0.013 vs.0.050±0.008;all P<0.05],but there were no significant differences in the levels of BUN,SCr and HbA1c between kidney injury group and simple diabetes group(all P>0.05).The levels of UMA and ACR in kidney injury group were significantly higher than those in simple diabetes group and control group[UMA(mg/L):41.57±9.20 vs.29.03±5.62,18.74±2.95;ACR(g/mol):32.95±5.63 vs.25.89±4.54,17.31±3.28;all P<0.05],and the levels of UMA and ACR in simple diabetes group were significantly higher than those in control group(all P<0.05).The levels of BUN,SCr,HbA1c,UMA and ACR in patients with T2DM combined with kidney injury after treatment were significantly lower than those before treatment[BUN(mmol/L):8.38±1.73 vs.6.29±1.32;SCR(μmol/L):94.57±15.20 vs.74.31±10.08;HbA1c:0.079±0.013 vs.0.064±0.011;UMA(mg/L):41.57±9.20 vs.29.74±7.69;ACR(g/mol):32.95±5.63 vs.26.19±4.37;all P<0.05].Conclusions The levels of HbA1c,UMA and ACR are all increased in patients with T2DM.In particular,UMA and ACR could sensitively reflect the renal injury in patients with T2DM,which could be used as auxiliary diagnostic indicators for early diagnosis,and could also evaluate the treatment effect of renal injury in patients with T2DM.