尿κ轻链、λ轻链、免疫球蛋白G和转铁蛋白联合检测对糖尿病早期肾损伤的预测价值

Predictive value of urinaryκlight chain,λlight chain,immunoglobulin G and transferrin combined detection in early renal injury in diabetes mellitus.

目的观察尿κ轻链、λ轻链、免疫球蛋白G(IgG)和转铁蛋白(TRF)联合检测对糖尿病早期肾损伤的预测价值。方法回顾性选取西安交通大学第二附属医院2022年3月至2023年3月收治的120例糖尿病患者作为研究对象,根据有无合并肾损伤将患者分为合并肾损伤组(n=45)与未合并肾损伤组(n=75)。检测两组患者的尿κ轻链、λ轻链、IgG、TRF水平以及Alb、血肌酐水平并予以对比,分析尿κ轻链、λ轻链、IgG、TRF与Alb、血肌酐的相关性,应用受试者操作特征(ROC)曲线评估4项指标联合检测对糖尿病早期肾损伤的预测价值。结果合并肾损伤组患者的尿κ轻链、λ轻链、IgG、TRF水平分别为(27.28±2.42)、(10.58±1.53)、(22.58±3.53)、(11.49±2.15)mg/L,均明显高于未合并肾损伤组[(10.48±2.14)、(3.63±0.84)、(5.34±0.98)、(2.24±0.45)mg/L],差异均有统计学意义(P<0.05)。合并肾损伤组患者的Alb、血肌酐水平分别为(46.43±6.42)mg/L、(124.31±13.63)μmol/L,均明显高于未合并肾损伤组[(21.41±2.54)mg/L、(74.28±10.48)μmol/L],差异均有统计学意义(P<0.05)。Pearson相关性分析显示,尿κ轻链、λ轻链、IgG、TRF水平与Alb、血肌酐呈明显正相关(P<0.05)。尿κ轻链、λ轻链、IgG、TRF水平联合检测预测糖尿病早期肾损伤的曲线下面积为0.884,敏感度为89.4%,特异度为78.7%。结论糖尿病早期肾损伤患者尿κ轻链、λ轻链、IgG、TRF水平均明显高于未合并肾损伤患者,且与早期肾损伤指标Alb、血肌酐密切相关。4项指标联合检测能够预测糖尿病早期肾损伤。

Objective To observe the predictive value of urinaryκlight chain,λlight chain,immunoglobulin G(IgG)and transferrin(TRF)combined detection in the early renal injury of diabetes mellitus.Methods A total of 120 diabetic patients admitted to The Second Affiliated Hospital of Xi'an Jiaotong University from March 2022 to March 2023 were retrospectively selected as the study objects,and were divided into the kidney injury group(n=45)and the without kidney injury group(n=75)according to whether they had kidney injury or not.The levels of urinaryκlight chain,λlight chain,IgG,TRF,Alb and serum blood creatinine of the two groups were detected and compared,and the correlation of urinaryκb light chain,λlight chain,IgG,TRF with Alb and serum blood creatinine was analyzed.The predictive value of the combined detection of four indicators for early renal injury in diabetes mellitus was evaluated using receiver operating characteristic(ROC)curve.Results The levels of urinaryκlight chain,λlight chain,IgG and TRF in the renal injury group were(27.28±2.42),(10.58±1.53),(22.58±3.53)and(11.49±2.15)mg/L,respectively,which were significantly higher than those in the non-renal injury group[(10.48±2.14),(3.63±0.84),(5.34±0.98)and(2.24±0.45)mg/L],and the differences were statistically significant(P<0.05).The levels of Alb and serum creatinine in patients with renal injury were(46.43±6.42)mg/L and(124.31±13.63)μmol/L,respectively,which were significantly higher than those in patients without renal injury[(21.41±2.54)mg/L,(74.28±10.48)μmol/L],the differences were statistically significant(P<0.05).Pearson correlation analysis showed that the levels of urinaryκlight chain,λlight chain,IgG and TRF were significantly positively correlated with Alb and serum creatinine(P<0.05).The area under the curve of combined detection of urinaryκlight chain,λlight chain,IgG and TRF levels in predicting early renal injury in diabetes was 0.884,the sensitivity was 89.4%,and the specificity was 78.7%.Conclusion The levels of urinaryκlight chain,λlight chain,IgG and TRF in patients with early renal injury in diabetes mellitus were significantly higher than those in patients without renal injury,and were closely related to early renal injury index Alb and serum creatinine.The combined detection of four indicators can predict early renal injury in diabetes.