血清中性粒细胞明胶酶相关脂质运载蛋白、胱抑素C及尿白蛋白肌酐比值、N-乙酰-β-D-氨基葡萄糖苷酶检测在早期糖尿病肾脏疾病中的应用价值  

Application value of serum neutrophil gelatinase-associated lipocalin, cystatin C,urinary albumin creatinine rate and N-acetyl-β-D-glucosaminidase in early diabetic kidney disease

作　　者：张会芬[1] 杨宏秀[1] 刘丽[1] 袁宝军[1] ZHANG Huifen;YANG Hongxiu;LIU Li;et al.(Department of Laboratory, Kailuan General Hospital, Tangshan 063000, Chin)

机构地区：[1]开滦总医院检验科,唐山063000

出　　处：《中国糖尿病杂志》2018年第4期309-315,共7页Chinese Journal of Diabetes

摘　　要：目的探讨血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、胱抑素C(Cys-C)及尿白蛋白肌酐比值(UACR)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)在早期糖尿病肾病(EDN)中的应用价值。方法选取eGFR>60 ml/(min·1.73 m^2)的T2DM患者430例,按UACR水平分为正常蛋白尿组(NA,UACR<30 mg/g)165例、微量蛋白尿组(MA,30≤UACR<300 mg/g)155例及大量蛋白尿组(HA,UACR≥300 mg/g)110例。另选门诊健康体检者175名为正常对照组(NC)。检测各组血NGAL、Cys-C及UACR、NAG水平并行统计学分析。结果与NC组比较,NA组NAG、NGAL升高,MA组NGAL、Cys-C、UACR、NAG也升高(P<0.01)。与NA组比较,MA组NGAL、UACR、NAG升高(P<0.01)。HA组各项指标较其他组升高(P<0.01)。相关性分析显示,UACR与NAG、Cys-C、NGAL均呈正相关(r为0.583、0.569、0.513)。多因素Logistic回归分析显示,Cys-C、UACR是EDN独立的风险因素。UACR、NAG、Cys-C、NGAL的受试者工作特征(ROC)曲线下面积(AUC)依次为0.973、0.864、0.778、0.759,单项检测NAG敏感性最高(90.2%),Cys-C特异性最大(94.5%)。结论 4种标志物与EDN密切相关,Cys-C、UACR是EDN独立的风险因素;NAG是早于尿白蛋白出现的反应肾小管间质损伤非常敏感的指标;NGAL作为一种新型的生物学标志物与EDN的损伤程度密切相关,是糖尿病肾脏疾病(DKD)发生发展重要的动态监测指标。4项指标联合检测的诊断效能最大(敏感性97.4%、特异性98.5%)。Objective To investigate the application value of serum neutrophil gelatinase-associated lipocalin （NGAL）, cystatin C （Cys-C）, urinary albumin creatfnine rate （UACR） and N-acetyl-β-D- glucosaminidase （NAG） in early diabetic nephropathy. Methods A total of 430 type 2 diabetes mellitus （T2DM） inpatients with estimated glomerular filtration rate （eGFR） 〉 60 ml/（min 1.73 m2 ） were divided into groups of normal albumin （NA, n= 165）, microalbumin （MA, n = 155）, high albumin （HA, n= 110）. 150 health people were selected as the normal control （NC）. All subjects had the detections of serum NGAL, Cys-C, urinary UACR and NAG. Results Compared with NC group, NA group had higher NGA L and NAG levels（P〈0. 01）, MA group had higher levels of NGAL, Cys-C, UACR and NAG （P〈0.01）. Compared with NA group, MA group had higher levels of NGAL, UACR and NAG（P〈0. 01）. Every index increased in HA group when compared with other 3 groups. Correlation analysis showed that UACR was positively correlated with NAG,Cys-C and NGAL （r= 0. 583,0. 569 and 0. 513, respectively）. Multiple logistic regression analysis showed that Cys-C and UACR were closely related independent predictor in early diabetic nephropathy. The ree4iver operator characteristic eurve（ROC） area under curve（AUC） of UACR （0. 973） was the biggest, following by NAG （0. 864）, Cys-C（0. 778） and NGAL（0. 759）. The sensitivity of NAG was the highest （90. 2%）, and the specificity of Cys-C was the biggest （94. 5%）. Conclusion These four markers were all closely related to early diabetic kidney disease （DKD）. Cys-C and UACR were independent risk factors for DKD. NAG is hypersensitive index for early renal tubuloirnterstitial injury and NGAL was hypersensitive and dynamic monitoring indicator in the development of diabetes. The four combined indexes have high diagnostic efficiency with sensitivity 97.4% and specificity 98. 5%.

关 键 词：糖尿病肾脏疾病 早期 中性粒细胞明胶酶相关脂质运载蛋白 胱抑素C 尿白蛋白肌酐比值 N-乙酰-Β-D-氨基葡萄糖苷酶 估算肾小球滤过率 

分 类 号：R446.1[医药卫生—诊断学] R587.2[医药卫生—临床医学] R692.9