血清胱抑素C、β_2-MG和尿NGAL联合检测对糖尿病肾病早期诊断的价值  

Clinical significance of joint detection of serum cystatin C,β_2-MG and urine NGAL for early diagnosis of diabetic nephropathy

作　　者：马红雨[1] 朱美财[1] 董磊[1] 孙立美 全首祯[1] 

机构地区：[1]空军总医院临床检验中心,北京100142

出　　处：《武警医学》2016年第10期1018-1021,1026,共5页Medical Journal of the Chinese People's Armed Police Force

基　　金：空军总医院基金(KZ20150147)

摘　　要：目的探讨血清胱抑素C(cystatin C,CysC)、β_2-微球蛋白(β_2-microglobulin,β_2-MG)、尿NGAL(neutrophil gelatinase-associated lipocalin,NGAL)联合检测在糖尿病肾病(daibetic nephropathy,DN)早期诊断的临床价值及其敏感度和特异性。方法根据尿蛋白检测结果,将92例已确诊为2型糖尿病的患者分为2组:正常蛋白尿组(A组)和微量蛋白尿组(B组)各46例,收集46名体检的健康人作为对照组。检测各组血清CysC、β_2-MG和尿NGAL等指标水平并进行统计学分析。结果 A、B两组CysC、β_2-MG较对照组明显升高,B组CysC(0.69±0.17)、β_2-MG(2.34±0.61)水平高于A组的CysC(0.57±0.097),β_2-MG(1.7±0.62)水平,差异有统计学意义(P<0.05)。A组和B组尿NGAL水平与对照组比较有统计学差异(P<0.01)。3项指标的联合预测因子的曲线下面积为0.956,大于0.90,说明在DN早期诊断中具有极高的敏感度和特异性。CysC、β_2-MG、尿NGAL与尿微量白蛋白/肌酐(UACR)、Urea等指标呈正相关(P<0.01)。结论 CysC、β_2-MG和尿NGAL 3项指标联合能有效提高DN早期诊断的敏感度和特异性,对疾病的早期诊断、病情监测、判断预后有重要的临床意义。Objective To investigate the clinical value,sensitivity and specificity of the combined detection of serum cystatin C,β_2-microglobulin and urine NGAL for early diagnosis of patients with diabetic nephropathy. Methods 92 diabetic inpatients were equally divided into normal albuminuria group（ Group A） and microalbuminuria group（ Group B） according to the urinary albumin to creatinine ratio（ UACR）. Another 46 healthy persons were selected as control group. Results Serum CysC and β_2-MG levels in Group A,B were significantly higher than those of control（ P 0. 05）,while the level of CysC（ 0. 69 ± 0. 17）,β_2-MG（ 2. 34 ± 0. 61）in Group B was higher than the level of CysC（ 0. 57 ± 0. 097）,β_2-MG（ 1. 7 ± 0. 62） in Group A（ P 0. 05）. The urine NGAL level in Group A and B was significantly higher than that of control（ P 0. 01）. The AUC of the joint detection factor was 0. 956,indicating the significantly higher sensitivity and specificity of this approach to early diagnosis of patients with DN,than individual detection. Serum CysC,β_2-MG and urine NGAL levels were positively correlated with UACR and urea levels（ P 0. 01）. Conclusion Serum CysC,β_2-MG and urine NGAL are sensitive indicators in the early diagnosis of DN. Joint detection can be great clinical significance for early diagnosis of DN as well as for monitoring patients＇ condition.

关 键 词：糖尿病肾病 胱抑素C Β2-微球蛋白 尿NGAL 

分 类 号：R446.1[医药卫生—诊断学] R587.2[医药卫生—临床医学]