Objective To investigate the changes of urinary microalbumin(mALB)and type B urinary na-triuretic peptide(BNP)in the patients with diabetic nephropathy(DN)complicating heart failure and their in-fluence on recent prognosis.Methods A total of 73 patients with diabetes mellitus(DN)complicating heart failure from January 2014 to December 2016 were selected as the observation group and 73 persons undergoing healthy physical examination were selected as the control group.The urinary mALB and BNP levels in the two groups and the patients with different heart function grades were analyzed.The receiver operating characteris-tic(ROC)curve and survival curve were drawn for analyzing their diagnostic value and influence on progno-sis.Results The levels of urinary mALB and BNP levels in the observation group were significantly higher than those in the control group,the difference was statistically significant(P< 0.05).In the observation group,the poorer the heart function,the more obvious the urinary mALB and BNP abnormality,the difference was statistically significant(P<0.05).When the critical value of urinary mALB for diagnosing DN complica-ting heart failure was 18.56 ng/L,the area under the curve(AUC),95% CI,sensitivity and specificity were 0.983,0.964 -0.999,0.986 and 0.900 respectively,the difference was statistically significant(P< 0.05);%目的 探讨尿微量清蛋白(mALB)和B型脑钠肽(BNP)水平在糖尿病肾病(DN)合并心力衰竭中的变化及对近期预后的影响.方法 选取2014年1月至2016年12月确诊为DN 合并心力衰竭患者73例作为观察组,另随机选取健康体检者73例作为对照组,分析两组及不同心功能分级患者尿mALB、BNP水平变化,绘制受试者工作特征(ROC)曲线和生存曲线分析其诊断价值和预后影响.结果 观察组尿mALB、BNP水平明显高于对照组,差异有统计学意义(P<0.05).观察组中,患者心功能水平越差,尿mALB、BNP水平异常越明显,差异有统计学意义(P<0.05).尿mALB诊断DN合并心力衰竭的临界值为18.56 ng/L时,曲线下面积(A UC)、95% C I、灵敏度和特异度分别为0.983、0.964~0.999、0.986和0.900,差异有统计学意义(P=0.000);BNP诊断 DN 合并心力衰竭的临界值为119.20 ng/L 时,AUC、95% CI、灵敏度和特异度分别为0.960、0.933~0.987、0.904和0.871,差异有统计学意义(P=0.000);两组联合诊断DN合并心力衰竭的临界值为51.24时,A UC、95% CI、灵敏度和特异度分别为0.990、0.976~1.000、0.959和0.986,差异有统计学意义(P= 0.000).观察组中不同心功能分级患者生存状况比较,差异有统计学意义(P=0.000).结论 尿mALB、BNP联合诊断DN合并心力衰竭具有更高价值,这两个指标水平越差,患者预后也越差.
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