尿微量清蛋白和BNP水平在糖尿病肾病合并心力衰竭中的变化及对近期预后的影响  

Changes of urinary microalbumin and BNP levels in patients with diabetic nephropathy complicating heart failure and their influence on recent prognosis

作　　者：马腾远 赵阳 MA Tengyuan;ZHAO Yang(Department of Clinical Laboratory,Desheng Teaching and Researching Center,Capital Medical University,Beijing 100120,China;Department of Clinical Laboratory,Desheng Community Health Service Center of Xicheng District,Beijing 100120,China;Department of Clinical Laboratory,Beijing Municipal Anorectal Hospital,Beijing 100120,China)

机构地区：[1]首都医科大学德胜教研中心检验科,北京100120 [2]北京市西城区德胜社区卫生服务中心检验科,北京100120 [3]北京市肛肠医院检验科,北京100120

出　　处：《国际检验医学杂志》2018年第6期668-671,共4页International Journal of Laboratory Medicine

基　　金：北京市科技计划重大项目(D09050704310904)

摘　　要：目的探讨尿微量清蛋白(mALB)和B型脑钠肽(BNP)水平在糖尿病肾病(DN)合并心力衰竭中的变化及对近期预后的影响。方法选取2014年1月至2016年12月确诊为DN合并心力衰竭患者73例作为观察组,另随机选取健康体检者73例作为对照组,分析两组及不同心功能分级患者尿mALB、BNP水平变化,绘制受试者工作特征(ROC)曲线和生存曲线分析其诊断价值和预后影响。结果观察组尿mALB、BNP水平明显高于对照组,差异有统计学意义(P<0.05)。观察组中,患者心功能水平越差,尿mALB、BNP水平异常越明显,差异有统计学意义(P<0.05)。尿mALB诊断DN合并心力衰竭的临界值为18.56ng/L时,曲线下面积(AUC)、95%CI、灵敏度和特异度分别为0.983、0.964~0.999、0.986和0.900,差异有统计学意义(P=0.000);BNP诊断DN合并心力衰竭的临界值为119.20ng/L时,AUC、95%CI、灵敏度和特异度分别为0.960、0.933~0.987、0.904和0.871,差异有统计学意义(P=0.000);两组联合诊断DN合并心力衰竭的临界值为51.24时,AUC、95%CI、灵敏度和特异度分别为0.990、0.976~1.000、0.959和0.986,差异有统计学意义(P=0.000)。观察组中不同心功能分级患者生存状况比较,差异有统计学意义(P=0.000)。结论尿mALB、BNP联合诊断DN合并心力衰竭具有更高价值,这两个指标水平越差,患者预后也越差。Objective To investigate the changes of urinary microalbumin(mALB)and type B urinary natriuretic peptide(BNP)in the patients with diabetic nephropathy(DN)complicating heart failure and their influence on recent prognosis.Methods A total of73patients with diabetes mellitus(DN)complicating heart failure from January2014to December2016were selected as the observation group and73persons undergoing healthy physical examination were selected as the control group.The urinary mALB and BNP levels in the two groups and the patients with different heart function grades were analyzed.The receiver operating characteristic(ROC)curve and survival curve were drawn for analyzing their diagnostic value and influence on prognosis.Results The levels of urinary mALB and BNP levels in the observation group were significantly higher than those in the control group,the difference was statistically significant(P<0.05).In the observation group,the poorer the heart function,the more obvious the urinary mALB and BNP abnormality,the difference was statistically significant(P<0.05).When the critical value of urinary mALB for diagnosing DN complicating heart failure was18.56ng/L,the area under the curve(AUC),95%CI,sensitivity and specificity were0.983,0.964-0.999,0.986and0.900respectively,the difference was statistically significant(P<0.05);when the critical value of BUN for diagnosing DN complicating heart failure was119.20ng/L,which were0.960,0.933-0.987,0.904and0.871respectively,the difference was statistically significant(P<0.05);when the critical value of their combination detection for diagnosing DN complicating heart failure was51.24,which were0.990,0.976-1.000,0.959and0.986respectively,the difference was statistically significant(P=0.000).The survival status in the observation group had statistical difference among the patients with different heart function grades(P=0.000).Conclusion The urinary mALB and BNP combination in the diagnosis of DN complicating heart failure has a higher value,the poorer their levels,the poorer the patient�

关 键 词：尿微量清蛋白 B型脑钠肽 糖尿病肾病 心力衰竭 生存曲线 

分 类 号：R541.6[医药卫生—心血管疾病]