5项指标联合检测在2型糖尿病早期急性肾损伤中的诊断价值及临床意义

Diagnostic value and clinical significance of combined detection of multiple indicators in early renal injury of type 2 diabetes mellitus

目的探讨尿液中性粒细胞相关载脂蛋白(NGAL)、肾脏损伤分子-1(KIM-1)、血清胱抑素-C(CysC)、血肌酐(SCr)及肾小球滤过率估计值(eGFR)联合检测在2型糖尿病早期肾损伤中的诊断价值。方法选取四会市人民医院2016年8月至2018年2月收治的2型糖尿病早期急性肾损伤(AKI)患者54例作为AKI组,慢性肾脏疾病(CKD)患者50例作为CKD组,另选取50例健康志愿者作为对照组,对3组对象NGAL、KIM-1、Cys-C、SCr及eGFR进行检测比较。结果 (1)AKI组NGAL、KIM-1、Cys-C及SCr水平高于CKD组,eGFR低于CKD组,差异均有统计学意义(P<0.05);AKI组NGAL、KIM-1、Cys-C及SCr水平高于对照组,eGFR低于对照组,差异均有统计学意义(P<0.05);CKD组NGAL、KIM-1、Cys-C及SCr水平高于对照组,eGFR低于对照组,差异均有统计学意义(P<0.05)。(2)AKI组1、2、3期患者NGAL、KIM-1、Cys-C及SCr水平逐渐升高,eGFR逐渐降低,差异均有统计学意义(P<0.05)。(3)AKI组患者NGAL、KIM-1、Cys-C水平与SCr呈正相关(P<0.05),与eGFR呈负相关(P<0.05);CKD组患者NGAL、KIM-1、Cys-C水平与SCr呈正相关(P<0.05),与eGFR呈负相关(P<0.05)。(4)病程、餐后血糖、KIM-1、Cys-C、SCr和eGFR是2型糖尿病肾损伤的独立危险因素。结论 2型糖尿病合并肾损伤患者采用尿液NGAL、KIM-1、血清Cys-C、SCr及eGFR多项指标联合检测,对2型糖尿病早期肾损伤的鉴别诊断有重要意义。

Objective To study the diagnostic value of urinary neutrophil-associated apolipoprotein(NGAL),kidney injury molecule-1(KIM-1),serum cystatin-C(Cys-C),serum creatinine(SCr)and glomerular filtration rate(eGFR)in patients with early renal injury in type 2 diabetes mellitus.Methods 54 patients with early acute kidney injury(AKI)of type 2 diabetes mellitus admitted to Sihui People′s Hospital from August 2016 to February 2018 were selected as AKI group and 50 patients with chronic kidney disease(CKD)as CKD group.Another 50 healthy volunteers were selected as control group.NGAL,KIM-1,Cys-C,Scr and eGFR were detected and compared among the three groups.Results The levels of NGAL,KIM-1,Cys-C and Scr in AKI group were higher than those in CKD group,and eGFR was lower than those in CKD group,and the differences were statistically significant(P<0.05).The levels of NGAL,KIM-1,Cys-C and Scr in AKI group were higher than those in control group,and the levels of eGFR were lower than those in control group,and the differences were statistically significant(P<0.05).The levels of NGAL,KIM-1,Cys-C and Scr in CKD group were higher than those in control group,and the levels of eGFR were lower than those in control group,and the differences were statistically significant(P<0.05).In AKI group,the levels of NGAL,KIM-1,Cys-C and Scr gradually increased and eGFR gradually decreased in stage 1,stage 2 and stage 3,and the differences were statistically significant(P<0.05).The levels of NGAL,KIM-1 and Cys-C in AKI group were positively correlated with SCr(P<0.05).The levels of NGAL,KIM-1 and Cys-C in CKD group were positively correlated with Scr(P<0.05),and it was negatively correlated with eGFR(P<0.05).Course of disease,postprandial blood sugar,KIM-1,Cys-C,Scr and eGFR were independent risk factors for renal injury in type 2 diabetes mellitus.Conclusion The combined detection of urine NGAL,KIM-1,serum Cys-C,Scr and eGFR in patients with type 2 diabetes mellitus complicated with renal injury is of great significance in the differential diagnosis of early renal injury in type 2 diabetes mellitus.