尿视黄醇结合蛋白、肾损伤分子-1及血胱抑素C在早期糖尿病肾病中的变化及其诊断价值  

The applications of urinary retinol binding protein,kidney injury molecule 1,serum cystatin in early diabetic nephropathy

作　　者：孔媛[1] 徐爽[1] 李萍[1] 梁琳琅[1] 

机构地区：[1]沈阳军区总医院内分泌科,100086

出　　处：《疑难病杂志》2017年第3期255-258,共4页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的观察尿液中视黄醇结合蛋白(RBP)、尿肾损伤分子-1(KIM-1)及血胱抑素C(CysC)在糖尿病肾病(DN)中的变化及诊断价值。方法选取2014年6月—2016年6月沈阳军区总医院内分泌科收治的DM患者124例作为研究对象,根据24 h尿微量白蛋白排泄率(UAER)分为正常白蛋白尿(NA)组35例,微量白蛋白尿(MA)组45例和临床白蛋白尿(CP)组44例,另选取35例健康体检者为健康对照组(CON组),记录各组临床资料,测定各组生化指标,应用ELISA法测定各组尿液RBP、KIM-1及血CysC水平。结果 NA组、MA组、CP组BMI、腰围(WC)、空腹血糖(FPG)、餐后2 h血糖(2 hPG)、空腹胰岛素(FINS)、胰岛抵抗指数(HOMA-IR)、血肌酐(SCr)、尿蛋白排泄率(UAER)、尿素氮(BUN)、RBP、KIM-1、CysC水平显著高于CON组(F=17.669、15.734、18.639、19.835、17.885、25.693、129.72、444.15、128.20、168.90、75.382、47.856,P均<0.01)。与NA组比,MA组、CP组BMI、WC、FPG、2hPG、HOMA-IR、SCr、UAER、Cys C、BUN、RBP、KIM-1水平较高(P均<0.01),而CP组血清SCr、CysC及尿UAER、BUN、RBP、KIM-1水平高于MA组(P<0.01)。受试者特异性曲线(ROC)分析,经ROC分析可知,尿RBP诊断DN的ROC曲线下面积(AUC)为0.712,95%CI(0.612~0.845);尿KIM-1诊断DN的AUC为0.682,95%CI(0.608~0.782);血CysC诊断DN的AUC为0.652,95%CI(0.526~0.712)。结论尿RBP、KIM-1及血CysC水平与早期DN发生有密切的关系,可作为DN早期诊断指标。Objective To evaluate the diagnostic value of urine application and retinol binding protein（RBP）,urinary kidney injury molecule 1（KIM-1） and serum cystalin C（Cys C） in diabetic nephropathy（DN）.Methods One hundred and twenty-four patients with type 2 diabetes mellitus（DM） were randomly divided into normal albuminuria（NA,n =35）,microalbuminuria（MA,n =45） and clinical white proteinuria group（CP,n =44） based on 24 h urinary albumin excretion rate（UAER）.Another 35 healthy subjects were selected as the control group.All clinical data were recorded in each group and the levels of urine RBP,KIM-1 and blood Cys C were measured with ELISA.Results The levels of fasting plasma glucose（FPG）,2h postprandial blood glucose（2 h PG）,Fasting insulin（FINS）,insulin resistance index（HOMA-IR）,serum creatinine（SCr）,blood urea nitrogen（BUN）,RBP,KIM-1,Cys C of NA group,MA group,CP groups were significantly higher than control group（F =17.669,F =15.734,F =18.639,F =19.835,F =17.885,F =25.693,P =0.000）.The levels of BMI,WC,FPG,2h PG,FINS,HOMA-IR,SCr,BUN,RBP,KIM-1,Cys C of MA group,CP group were higher than NA group（P〈0.05）.The levels of RBP,KIM-1,Cys C of MA group were higher than CP group（F =129.72,F =444.15,F =128.20,F =168.90,F =75.382,F =47.862,P =0.000）.The area under the ROC curve of urinary RBP diagnosis of DN（AUC）was 0.712,95%CI 0.612 to 0.845）;urinary KIM-1.diagnostic DN AUC of 0.672,95%CI 0.608 to0.782）;blood Cys C diagnosis of DN AUC was 0.602,95%CI 0.526 to 0.712）.Conclusion The levels of RBP,KIM-1 and Cys C in urine were closely related to the occurrence of early DN,which could be used as an early diagnostic index of DN.

关 键 词：胱抑素C 视黄醇结合蛋白分子-1 肾损伤分子-1 糖尿病肾病 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]