血清游离脂肪酸和尿足细胞标志蛋白检测在2型糖尿病肾病中的诊断价值

摘要

目的 探讨血清游离脂肪酸(free fatty acid,FFA)及尿足细胞标志蛋白(podocalyxin,PCX)在2型糖尿病肾病(diabeticnephropathy,DN)中的诊断价值.方法 选取120例2型糖尿病患者,依据尿清蛋白/尿肌酐比值(urinary albumin-creatinineratio,UACR)将患者分为正常清蛋白尿组(NA)、微量清蛋白尿组(MA)和大量清蛋白尿(LA)3组;选取同期体检健康者40例作为对照组.检测各组血清FFA和尿PCX水平并进行相关性分析,采用ROC曲线评估其对DN的诊断价值.结果 NA组、MA组、LA组以及健康人对照组血清FFA检测结果分别为(0.61±0.14)、(0.81±0.13)、(0.95±0.18)和(0.49±0.11)mmol/L,尿PCX检测结果分别为(1.86±0.45)、(4.47±1.48)、(6.72±1.40)和(1.38±0.24) ng/mL,糖尿病患者血清FFA和尿PCX均高于健康人对照组,差异有统计学意义(P均＜0.05),并随着疾病进展而升高.Pearson相关分析显示,血清FFA与尿PCX呈正相关(r=0.73,P＜0.05).血清FFA和尿PCX单独检测诊断DN的敏感性分别为74.1％和80.6％,联合检测的敏感性为89.5％ (P ＜0.05).结论 2型糖尿病患者肾损伤时血清FFA和PCX明显升高,两者对于DN诊断具有重要的临床价值.%Objective To investigate the diagnostic values of serum free fatty acids (FFA) and urine podocalyxin (PCX) in the patients with type 2 diabetic nephropathy(DN).Methods A total of 120 patients with type 2 diabetes mellitus (DM) were enrolled,and they were divided into three groups,normal albumin group(NA),microalbuminuria group(MA) and heavy albuminuria group(HA),based on the urinary albumin-creatinine ratio(UACR).In addition,40 healthy persons participated in medical examination were selected as the control group.Serum FFA levels were detected by a biochemical analyzer and urine PCX levels by ELISA.The correlation between them was analyzed by Pearson correlation,and their diagnostic values in type 2 DN were evaluated by the receiver operating characteristic curve (ROC).Results Serum FFA levels in the NA,MA,HA and control groups were (0.61 ± 0.14),(0.81 ± 0.13),(0.95 ± 0.18) and (0.49 ± 0.11) mmol/L,respectively,and urine PCX levels were (1.86 ± 0.45),(4.47 ± 1.48),(6.72 ± 1.40)and(1.38 ±0.24) ng/mL,respectively.The levels of serum FFA and urine PCX in type 2 DM patients were significantly higher than those in the control group(P ＜ 0.05),and increased with the progression of type 2 DM.Pearson correlation analysis showed that serum FFA levels were positively correlated with urine PCX levels(r =0.73,P ＜ 0.05).The sensitivity of serum FFA,urine PCX and combined detection in the diagnosis of type 2 DN were 74.1％,80.6％ and 89.5％,respectively,and the latter significantly higher than the former two (P ＜ 0.05).Conclusion Serum FFA and urine PCX levels increase significantly in diabetic patients with renal injury,and both of them have important clinical values in the diagnosis of type 2 DN.