赖天寿,谭柏松,丘仲柳
LAI Tianshou,TAN Baisong,QIU Zhongliu

• 1:南方医科大学附属新会人民医院检验科

摘要(Abstract)：

目的:探讨微量白蛋白(mAlb)、血清光抑素(Cys-c)和β2-微球蛋白(β2-MG)联合检测在糖尿病肾病(DKD)早期诊断中应用价值。方法:选择2型糖尿病患者110例,根据尿蛋白排出水平分为尿蛋白排出微量组56例(微量组)、尿蛋白排出大量组54例(大量组),另选取55例同时期健康人作为对照组;测定3组受检者尿中mAlb和血中Cys-c及β2-MG的水平,分析三个指标与DKD发病风险的关联性,以及mAlb、Cys-c及β2-MG联合检测早期诊断DKD的准确性。结果:大量组mAlb、Cys-c及β2-MG浓度分别为(94.27±12.86)mg/L、(15.85±2.62)mg/L及(6.60±1.15)mg/L,均显著高于微量组(36.22±5.40)mg/L、(6.91±1.84)mg/L、(3.20±0.71)mg/L和对照组(9.48±1.750)mg/L、(1.02±0.37)mg/L、(1.43±0.60)mg/L,差异有统计学意义(P<0.05);mAlb、Cys-c及β2-MG与DKD发病风险的关联系数分别为3.87、3.29和3.65,存在显著正相关(P<0.05);mAlb、Cys-c和β2-MG三者联合检测早期诊断DKD灵敏度、特异性和诊断符合率分别达到93.45%、95.12%和94.05%,均显著高于三者单独检测(P<0.05),假阳性率和假阴性率仅为4.88%和6.55%,均显著低于三者单独检测的值(P<0.05)。结论:mAlb、Cys-c及β2-MG与糖尿病患者肾功能损伤存在正相关,mAlb、Cys-c及β2-MG联合检测对DKD患者早期诊断具有较高的准确性,可作为DKD早期预测的参考之一。
Objective: To investigate the application value of albumin(mAlb) combined with serum cystatin(Cys-c) and β2-microglobulin(β2-MG) in the early diagnosis of the diabetic kidney disease.Methods: A total of 110 cases with type 2 diabetes were selected and divided into a little urine protein excretion groups(n = 56,group A),and a great quantity of urinary protein excretion groups(n = 54,group B) according to the urinary protein excretion levels and 55 healthy people were selected as control group(n = 55,group C). The urine levels of mAlb and the serum levels Cys-c and β2-MG of each group were determined and the differences in each index of the three groups were compared. The correlation between the level of mAlb,β2-MG,Cys-C and the risk of the DKD were analyzed,as well as the detection accuracy of mAlb,β2-MG and Cys-C in diagnosis of DKD. Results: The mAlb,Cys-c and β2-MG levels of the group A [(94. 27 ± 12. 86) mg /L,(15. 85 ± 2. 62) mg /L,(6. 60 ±1. 15) mg /L]were significantly higher than those of group B [(36. 22 ± 5. 40)mg /L,(6. 91 ± 1. 84)mg /L,(3. 20 ± 0. 71)mg /L]and group C [(9. 48 ± 1. 750) mg /L,(1. 02 ± 0. 37) mg /L,(1. 43 ±0. 60)mg /L ](P < 0. 05). The correlation coefficients of mAlb,Cys-c,β2-MG with the risk of DKD were 3. 87,3. 29 and 3. 65 respectively,and there was a significant positive correlation(P < 0. 05).The sensitivity,specificity and diagnostic accordance rate of mAlb combined with Cys-c and β2-MG in early diagnosis of DKD reached 93. 45%,95. 12% and 94. 05% respectively,which were significantly higher than those detected individually(P < 0. 05) while the false positive rate and false negative rate of only 4. 88% and 6. 55%,which were significantly lower than those detected individually( P <0. 05). Conclusions: There is positive correlation between the mAlb,Cys-c,β2-MG levels and the renal injury in early stage of DKD. mAlb combined with Cys-c and β2-MG detection have high accuracy in early diagnosis of diabetic nephropathy and provide references for forecast DKD.

关键词(KeyWords)： 微量白蛋白;血清光抑素;β2-微球蛋白;糖尿病肾病;诊断,早期
albumin;serum cystatin;β2-microglobulin;diabetic kidney disease;diagnosis,early

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 赖天寿,谭柏松,丘仲柳
LAI Tianshou,TAN Baisong,QIU Zhongliu

DOI: 10.19367/j.cnki.1000-2707.2014.03.025

参考文献(References)：

• [1]郝玉杰,王运红,王桂英,等.肾康注射液联合厄贝沙坦对糖尿病肾病微量白蛋白的影响[J].贵阳医学院学报,2010(35):56-58.
• [2]Philops JC,Marchand M,Scheen AJ,et al.Pulse pressure and cardiovascular autonomic neuropathy according to duration of type 1 diabetes[J].Diabetes Metab Res Rev,2011(1):442-451.
• [3]李海新,房大明,董永双,等.同型半胱氨酸联合血清胱抑素C检测在糖尿病肾病早期诊断中的价值[J].河北医药,2013(5):711-712.
• [4]陈靖.糖尿病肾病早期诊断及肾活检指征[J].肾脏病与透析肾移植杂志,2011(20):349-351.
• [5]孙红喜,陈莉明,常宝成,等.动态血压节律变化在糖尿病肾病早期诊断中的价值[J].中华内分泌代谢杂志,2013(29):368-373.
• [6]黄昭华,曹壮,史耀勋.糖尿病肾病的早期诊断与预防[J].中医药导报,2010(7):11-12.
• [7]李明,陈慧卿,赵文波,等.KDIGO慢性肾脏病分级系统在1645例2型糖尿病患者伴发肾脏疾病及相关血管性疾病中的应用[J].中华肾脏病杂志,2013(12):877-882.
• [8]司马剑华,季叶湘,周晓燕.血清半胱氨酸蛋白酶抑制剂C测定对糖尿病肾病早期诊断的意义[J].医学检验,2011(26):359-360.
• [9]黄金.β2-微球蛋白在糖尿病肾病早期诊断中的价值[J].河北医学,2011(18):1655-1657.
• [10]郭春霞.血清胱抑素C及IgG联合尿微量白蛋白及微球蛋白检测对糖尿病肾病早期诊断的意义[J].中国医药,2012(7):1416-1417.
• [11]李世葵.血清胱抑素C与尿微量白蛋白联合检测在糖尿病肾病早期诊断的意义[J].中国美容医学,2011(20):98.
• [12]李福萍.尿微量白蛋白、血清β2微球蛋白与胱抑素C在早期糖尿病肾病诊断中的意义[J].中国医师杂志,2013(5):702-703.

文章评论(Comment)：