多项尿蛋白联合筛查对糖尿病肾病早期诊断的临床价值

摘要

目的：探讨多项尿蛋白联合检测对糖尿病肾病(DN)早期诊断的临床价值。方法：选取76例DN患者作为观察组，并根据干化学法检测的尿蛋白定性结果将其进一步分为弱阳性(±)DN组(9例)，阳性(+)DN组(9例)，强阳性(++)DN组(30例)，超强阳性(+++)DN组(28例)；同时选择60名健康体检者作为对照组。采用免疫散射比浊法分别检测观察组与对照组的尿液微量白蛋白(mAlb)、α1-微球蛋白(α1-MG)、β2-微球蛋白(β2-MG)、转铁蛋白(TRF)以及免疫球蛋白G(IgG)项目；采用化学比色法检测24 h尿蛋白(UTP)项目；采用干化学试纸条法检测尿蛋白定性项目，并比较两组各项尿蛋白检测结果。结果：观察组mAlb、IgG及TRF与对照组相比，其差异有明显统计学意义(Z=-3.43，Z=-2.61，Z=-3.51；P＜0.01)。UTP项目尿蛋白弱阳性DN组与对照组相比，差异有统计学意义(Z=-2.11，P＜0.05)；尿蛋白阳性、强阳性及超强阳性DN组与对照组相比，其差异有明显统计学意义(Z=-2.66，Z=-2.89，Z=-4.03；P＜0.01)。α1-MG和β2-MG两项：尿蛋白弱阳性DN组和尿蛋白阳性DN组与对照组相比无差异；尿蛋白强阳性DN组和尿蛋白超强阳性DN组与对照组相比，其差异有明显统计学意义(Z=-3.89，Z=-5.37，Z=-2.64，Z=-3.71；P＜0.01)。结论：多项尿蛋白联合检测对诊断早期DN有较高的临床价值，尤其是mAlb、IgG及TRF三项对DN早期诊断更具有临床意义。%Objective: To explore the diagnostic value of six urine proteins in early diabetic nephropathy(DN). Methods: Seventy six patients were divided in to five kinds of proteins of the DN group and the healthy control group(HC), including urine albumin (mAlb),α1-microglobulin(α1-MG),β2-microglobulin (β2-MG), transferrin (TRF) and immunoglobulin G(IgG) proteins were detected by immune nephelometry;24-hour urine total protein (UTP) was detected by chemical colorimetric method, urine protein was detected using a chemical urine strip. The DN group is further divided into four groups (±,+,++,+++)according to the degree of urine protein. The above five kinds of urine proteins and UTP were compared with HC group respectively. Results:There were significant differences between each DN groups and HC group on mAlb, IgG and TRF(Z=-3.43, Z=-2.61, Z=-3.51;P<0.01). The UTP showed statistical difference between DN (±) group and HC group with (Z=-2.11;P<0.05), and also the other three DN(+,++,+++) groups with P<0.01. There were statistical differences between the DN (++,+++) group and HC group with (Z=-3.89, Z=-5.37, Z=-2.64, Z=-3.71;P<0.01) onα1-MG andβ2-MG ,while the DN(±,+) group with P>0.05. Conclusion:Combined detection of multiple urine proteins has high clinical value in early diagnosis of DN, and mAlb, IgG and TRF showed more clinical significance for the early diagnosis of DN especially.