血清C1q和NGAL及CysC联合检测对早期糖尿病肾病辅助诊断的临床评价  

Clinical evaluation of assisted diagnosis of early diabetic kidney disease by serum Clq, NGAL and CysC

作　　者：樊玲英 俸家富 Fan Lingying;Feng Jiafu(Department of Clinical Medicine of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学临床医学系,泸州646000 [2]西南医科大学附属绵阳市中心医院检验科

出　　处：《中华检验医学杂志》2018年第11期847-852,共6页Chinese Journal of Laboratory Medicine

基　　金：国家973计划子课题（2015CB755402-043）;四川省科技厅科技支撑计划项目（2015SZ0117）

摘　　要：目的探讨血清补体组分1q（C1q）、半胱氨酸蛋白酶抑制剂C（CysC）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、肌酸酐（SCr）和尿素（SUr）检测对早期糖尿病肾病（EDKD）的诊断价值。方法回顾性研究方法。收集2017年3至11月绵阳市中心医院就诊或体检的受试者530例，其中229例糖尿病（DM组）患者被分为单纯糖尿病组（SDM组，n＝100例）和EDKD组（n＝129例），301名体检者作为健康对照组（HC组）。测定受试者血清C1q、CysC、NGAL、SCr和SUr，评价这些指标单独检测和联合检测对EDKD的诊断性能。采用单因素方差分析比较各组间检测指标的差异，用受试者工作特征曲线评价所观察指标的诊断性能。结果受试者血清C1q、CysC、NGAL、SCr水平（中位数），早期糖尿病肾病组分别为：187.80 mg/L、1.02 mg/L、148.70 μg/L、72.00 μmol/L；单纯糖尿病组分别为：177.00 mg/L、0.80 mg/L、116.20 μg/L、55.35 μmol/L；健康对照组：163.60 mg/L、0.75 mg/L、104.20 μg/L、59.40 μmol/L。早期糖尿病肾病组血清C1q、CysC、NGAL、SCr和SUr水平均显著高于单纯糖尿病组（t1值分别为6.50、9.44、3.87、9.19和4.34，P〈0.05）和健康对照组（t2值分别为7.26、12.54、5.86、6.16和6.49，P〈0.05）。ROC曲线分析显示，单独检测时，CysC（AUC＝0.837）对EDKD的诊断性能明显高于C1q（AUC＝0.731）、NGAL（0.742）和SCr（AUC＝0.720）（均P〈0.05）；两两联合检测时，C1q＋CysC的诊断性能较好（AUC＝0.890，Se＝79.1%, Sp＝86.5%, YI＝0.656）。在此基础上，增加检测NGAL（z＝1.817，P〉0.05）或NGAL＋SCr （z＝1.806，P〉0.05）未显著改善对EDKD的诊断性能。结论C1q、CysC和NGAL对EDKD的诊断优于SCr和SUr，其中C1q和CysC联合检测对EDKD具有更好的诊断性能。ObjectiveTo investigate the diagnostic value of serum complement component 1 q （C1q）, cystatin C （CysC）, neutrophil gelatinase-associated lipocalin （NGAL）, creatinine （SCr） and urea （SUr） for early diabetic kidney disease.MethodsA retrospective study was conducted in 530 subjects who visited or received physical examination in Mianyang Central Hospital from March 2017 to November 2017. Of these, 229 patients with diabetes mellitus （DM group） were divided into simple diabetes mellitus group （SDM group, n=100） and early diabetic kidney disease group （EDKD group, n=129） respectively, and 301 subjects were selected as the healthy control （HC group）. The levels of serum C1q, CysC, NGAL, SCr and SUr were detected in all subjects. Then, the diagnostic values of single and combined detection of these indexes for early diabetic kidney disease were evaluated. The statistical difference among the observed indexes of each group were compared by one-way ANOVA, and the diagnostic performance of those indexes were evaluated by receiver operating characteristic curve（ROC） analysis.ResultsThe median of serum C1q, CysC, NGAL and SCr in early diabetic kidney disease group were 187.80 mg/L, 1.02 mg/L, 148.70 μg/L and 72.00 μmol/L. The simple diabetes mellitus group were 177.00 mg/L, 0.80 mg/L, 116.20 μg/L and 55.35 μmol/L. The healthy control group were 163.60 mg/L, 0.75 mg/L, 104.20 μg/L and 59.40 μmol/L. Compared with simple diabetes group （t1 values were 6.50, 9.44, 3.87, 9.19 and 4.34, P〈0.05）and healthy control group（t2 values were 7.26, 12.54, 5.86, 6.16 and 6.49, P〈0.05）, the levels of serum C1q, CysC, NGAL, SCr and SUr in diabetic kidney disease group were significantly increased. According to the ROC curve analysis, the diagnostic performance of CysC（AUC=0.837）was much higher than those of C1q（AUC=0.731）, NGAL（0.742）and SCr（AUC=0.720）for early diabetic kidney disease by using single detection. Otherwise, combined the diagnostic performance of joint de

关 键 词：早期糖尿病肾病 补体C1Q 半胱氨酸蛋白酶抑制剂C 中性粒细胞明胶酶相 关脂质运载蛋白 肌酸酐 

分 类 号：R587.2[医药卫生—内分泌]