五项肾功能生化检测指标对糖尿病肾功能损伤的诊断价值

摘要

Objective To explore the significance of levels of microalbuminuria( MA),cystatin C( Cys C),β2- microglobulin(β2-MG),retinol binding protein( RBP)and urinary N-acetyl-D-glucosaminidase( NAG)in early detection of impairment of renal function in patients with diabetes mellitus. Methods A total of 50 healthy persons and 200 patients with diabetes mellitus were selected for this study,blood samples were collected and microalbuminuria( MA),cystatin C( Cys C),β2- microglobulin(β2-MG),retinol binding protein( RBP)and urinary N-acetyl-D- glucosaminidase( NAG )were detected. The detection of biochemical indicators of renal function was analyzed with ROC. Results Levels of Cys C,BUN,β2-MG,Cr,RBP and NAG in control group,normal albuminuria group,microalbuminuria group and clinical albuminuria group showed a gradually increasing trend( P <0. 05). Positive rates of indicators in NC group,NA group,MA group and CP group were gradually increased( P <0. 05). The highest diagnostic specificity and sensitivity for diabetic nephropathy was Cys-C,with sen-sitivity of 80% and specificity of 84%,followed by NAG andβ2-MG. Conclusion The 5 indicators as MA,CysC,β2-MG,RBP and NAG are useful in detection of early impairment of renal function in diabetic patients.%目的：探讨尿微量白蛋白（ MA）、胱抑素C（ Cys C）、β2-微球蛋白（β2-MG）、视黄醛结合蛋白（ RBP）、尿N-乙酰-D-氨基葡萄糖苷酶（ NAG）5项肾功能生化检测指标诊断糖尿病早期肾损伤的临床价值。方法选择健康者50例（ NC组）和糖尿病患者200例[其中正常白蛋白尿组（ NA组）72例，微量白蛋白尿组（ MA组）70例，临床白蛋白尿组（ CP组）58例]为研究对象，采集血样和尿液并测定、分析MA Cys C β2-MG RBP NAG 指标。比较糖尿病患者与健康对照者间肾功能生化检测指标水平，采用ROC曲线分析5项生化指标诊断糖尿病早期肾损伤的临床价值。结果MA Cys C β2-MG RBP NAG 等指标在NC组、NA组、MA组、CP组间呈逐步升高的趋势（ P <0.05）；上述指标阳性率在对照组组、正常白蛋白尿组、微量白蛋白尿组、临床白蛋白尿组间逐步升高（ P <0.05）；各项肾功能指标间具有正相关关系（ P <0.05）。诊断糖尿病肾病特异度和灵敏度最高的是Cys-C，灵敏度为80.0%，特异度为84.0%，其次为NAG、β2-MG。结论 MA Cys C β2-MG RBP NAG 5项肾功能生化检测指标对糖尿病患者的早期肾功能损伤具有一定的指示作用，有助于发现糖尿病患者的早期肾功能损害。