尿ACR、β_2-MG及血胱抑素C对糖尿病肾病早期诊断价值及相关性研究  

Diagnostic value of urinary ACR,β_2-MG and cystatin C for early diagnosis of diabetic nephropathy and correlation study

作　　者：王姗姗[1] 陈光明[1] WANG Shanshan;CHEN Guangming(Department of Endocrinology and Metabolism,Jinhua Central Hospital in Zhejiang Province,Jinhua 321000,China)

机构地区：[1]浙江省金华市中心医院内分泌代谢科,浙江金华321000

出　　处：《中国现代医生》2018年第33期27-30,共4页China Modern Doctor

基　　金：浙江省医药卫生一般研究计划(2015KYB418)

摘　　要：目的探讨尿白蛋白/肌酐比(ACR)、β_2-微球蛋白(β_2-MG)和血胱抑素C(Cys C)对糖尿病肾病的早期诊断价值及相关性研究,为临床诊治糖尿病肾病提供参考依据。方法选取2型糖尿病(T2DM)患者140例,A组尿蛋白阴性者73例,B组尿蛋白微量者67例,健康对照组54例。检测三组尿ACR、β_2-MG、Cys C等临床指标并进行统计分析。结果三组年龄、性别、总胆固醇、Scr、LDL-C、HDL-C、BUN差异无统计学意义(P>0.05)。A、B组的病程、BMI、GLU、Hcy、UA、HbA1c、ACR、Cys C、β_2-MG的水平显著高于对照组(P<0.05),并且B组又显著高于A组(P<0.05);ACR、Cys C、β_2-MG水平在尿蛋白阴性组有上升,但在DM早期肾病中三者联合检测的灵敏度更高。多元回归分析结果显示病程、HbA1c、Hcy、UA、BMI因素是DM早期肾病发生、发展的影响因素。相关性分析显示ACR、Cys C、β_2-MG与病程、BMI、HbA1c、UA、Hcy等影响因素呈正相关(P<0.05)。结论尿ACR、β_2-MG和血Cys C联合检测可动态地反映肾小球和肾小管的变化,对于指导临床糖尿病早期肾病的诊断、治疗及监测病情等方面有重大的意义。Objective To investigate the early diagnostic value and correlation of urinary albumin/creatinine ratio(ACR),β2-microglobulin(β2-MG)and cystatin C(Cys C)in diabetic nephropathy,and to provide a reference for clinical diagnosis and treatment of diabetic nephropathy.Methods A total of140patients with type2diabetes mellitus(T2DM)were selected,including73patients with urinary protein negative in group A,and67patients with urinary protein in group B.And there were54cases in healthy control group.The clinical indicators such as urinary ACR,β2-MG and Cys C in three groups were detected and statistically analyzed.Results There were no significant differences in age,gender,total cholesterol,Scr,LDL-C,HDL-C and BUN among the three groups(P>0.05).The disease course,BMI,GLU,Hcy,UA,HbA1c,ACR,Cys C,β2-MG levels in group A and group B were significantly higher than those in the control group(P<0.05),and those of the group B were significantly higher than those of the group A(P<0.05).ACR,Cys C,andβ2-MG levels were increased in the urine protein negative group.But in the DM early kidney disease,the sensitivity of joint detection was higher.Multiple regression analysis showed that the course of disease,HbA1c,Hcy,UA,BMI factors were the influencing factors of the occurrence and development of DM early nephropathy.Correlation analysis showed that ACR,Cys C,β2-MG were positively correlated with disease duration,BMI,HbA1c,UA,Hcy and other factors(P<0.05).Conclusion The combined detection of urinary ACR,β2-MG and blood Cys C can dynamically reflect the changes of glomeruli and renal tubules,which is of great significance for guiding the diagnosis,treatment and monitoring of early diabetic nephropathy.

关 键 词：2型糖尿病肾病 尿白蛋白/肌酐比 胱抑素C Β2-微球蛋白 

分 类 号：R587.2[医药卫生—内分泌]