ROC曲线评价血清胱抑素C在糖尿病肾病中的诊断价值  

Evaluation with ROC curve of the diagnostic value of serum cystatin C for diabetic nephropathy

作　　者：程莹[1] 李宁娜[1] 刘君静[1] 罗鸣[1] 艾智华[1] 

机构地区：[1]成都军区总医院内分泌科,成都610083

出　　处：《西南国防医药》2014年第7期715-718,共4页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的利用ROC曲线评价胱抑素C(Cys C)诊断2型糖尿病肾损害的价值。方法 120例2型糖尿病患者测量身高、体重和血尿素氮(BUN)、肌酐(SCr)、Cys C水平及尿微量蛋白肌酐比值(ACR),利用CKD-EPI公式计算肾小球滤过率(eGFR),对Cys C与eGFR进行相关性分析,利用ROC曲线评估Cys C诊断2型糖尿病肾损害的价值,根据Youden指数确定诊断切点。对eGFR与Cys C诊断慢性肾损害的一致性进行Kappa检验。结果 (1)eGFR<60 ml/(min·1.73 m2)组患者的年龄、BUN、SCr、Cys C和ACR水平均明显高于eGFR≥60 ml/(min·1.73 m2)组;(2)Cys C与eGFR之间呈负相关(r=-0.808);(3)Cys C诊断慢性肾损害的ROC曲线下面积为0.944(P=0.000),诊断切点为Cys C>1.18 mg/L,灵敏度为82.6%,特异度为93.8%;(4)Cys C与eGFR诊断慢性肾损害一致性的Kappa值为0.709,二者一致性较好。结论 Cys C水平升高能够反映糖尿病患者GFR的下降,Cys C>1.18 mg/L可以作为诊断糖尿病慢性肾损害的切点。Objective To evaluate the diagnostic value of cystatin C（Cys C）for kidney damage in patients with type 2 diabetes mellitus via receiver operating characteristic（ROC）curve. Methods 120 patients with type 2 diabetes mellitus were selected and the following data were collected：anthropometric indexes,blood urea nitrogen（BUN）,serum creatine（SCr）,serum Cys C and＆amp;nbsp;albuminuria creatine ratio（ACR）;the estimated GFR（eGFR）was gained through CKD-EPI equation;a correlation analysis was made between Cys C and eGFR;ROC curve was applied to evaluate the diagnostic value of Cys C for kidney damage and cut-off point was determined by Youden index;Kappa test was performed to check the consistency of eGFR and Cys C in diagnosing chronic renal damage. Results （1）Age,BUN,SCr,Cys C and ACR of the patients in eGFR ﹤ 60 ml/（min·1. 73 m2 ）group were in higher level than those of the patients in eGFR≥60 ml/（min·1. 73 m2 ）group;（2）There existed a negative correlation between Cys C and eGFR （r = - 0. 808）;（3）The area under ROC curve of the diagnosis of Cys C for chronic kidney damage was 0. 944（P = 0. 000）and the cut-off point was ﹥ 1. 18 mg/ L;the sensitivity was 82. 6% and the specificity was 93. 8% ;（4）The consistency between Cys C and eGFR was good with the Kappa value of 0. 709. Conclusions Elevated Cys C is a sensitive index for decreased GFR in patients with type 2 diabetes mellitus;Cys C ﹥ 1. 18 mg/ L can be taken as the diagnostic cut-off point of chronic kidney damage in patients with type 2 diabetes mellitus.

关 键 词：糖尿病肾病 肾小球滤过率 ROC曲线 

分 类 号：R587.1[医药卫生—内分泌]