血清Hcy及尿TRF、IgG、α1MG、NAG对2型糖尿病肾病的早期诊断价值  

Early diagnostic value of serum Hcy and urine TRF,IgG,α1MG,NAGin type 2 diabetic nephropathy

作　　者：高倩 宋燕[1] 王兵 王琳琳 李晓静 徐旭[1] 梁国威[1] GAO Qian;SONG Yan;WANG Bing;WANG Linlin;LI Xiaojing;XU Xu;LIANG Guowei(Department of Clinical Laboratory,Aerospace Center Hospital,Beijing 100049,China;Department of Endocrinology,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院检验科,北京100049 [2]航天中心医院内分泌科,北京100049

出　　处：《国际检验医学杂志》2021年第3期343-347,共5页International Journal of Laboratory Medicine

摘　　要：目的探讨血清同型半胱氨酸(Hcy)、尿转铁蛋白(TRF)、尿免疫球蛋白G(IgG)、尿α1微球蛋白(α1MG)和尿N-乙酰-β-D氨基葡萄糖苷酶(NAG)对2型糖尿病(T2DM)患者糖尿病肾病(DN)的早期诊断价值。方法选择该院2015年1月至2019年9月收治的T2DM患者99例,根据尿微量清蛋白水平分为T2DM组(59例)、早期DN组(EDN组,21例)和DN组(19例);另收集同期该院体检中心体检健康者25例作为健康对照(NC)组。对T2DM组、EDN组、DN组临床表现、查体、糖尿病及其并发症发病情况,血清Hcy、尿TRF、IgG、α1MG、NAG及其影响因素进行回顾性分析,并与NC组进行比较。分析各组差异并绘制受试者工作特征曲线(ROC曲线)。结果EDN组、DN组与T2DM组和NC组比较,血清Hcy、IgG、α1MG、TRF水平显著升高,DN组尿TRF水平较EDN组进一步升高,尿NAG水平仅在DN组升高。血清Hcy及尿NAG、IgG、α1MG、TRF的ROC曲线下面积(95%CI)、灵敏度和特异度分别为0.755(0.670~0.828)、65.00%、83.30%,0.654(0.555~0.744)、67.70%、66.20%,0.960(0.903~0.988)、83.80%、95.90%,0.792(0.702~0.865)、74.20%、78.30%,0.841(0.757~0.905)、67.70%、97.00%。尿液IgG和TRF 2个指标联合诊断的ROC曲线下面积为0.968(0.914~0.993),诊断灵敏度为87.10%,特异度为93.20%。结论血清Hcy及尿α1MG、NAG对DN有辅助诊断价值,尿TRF和IgG联合检测可提高DN的早期诊断效能。Objective To investigate the early diagnostic value of serum homocysteine(Hcy),urinary transferrin(TRF),urinary immunoglobulin G(IgG),urinaryα1-microglobulin(α1MG)and urinary N-acetyl-β-D-glucosaminidase(NAG)in the early diagnosis of diabetic nephropathy(DN)in type 2 diabetes mellitus(T2DM).Methods A total of 99 patients with T2DM admitted to the hospital from January 2015 to September 2019 were selected and divided into T2DM group(59 cases),early DN group(EDN group,21 cases)and DN group(19 cases)according to the level of urinary microalbumin;25 healthy subjects in the physical examination center of our hospital were collected as the NC group.The clinical manifestations,physical examination,incidence of diabetes mellitus and its complications,serum Hcy and urine TRF,IgG,α1MG,NAG and influencing factors were analyzed retrospectively,and compared with those of NC group in the same period.The differences were analyzed and the working characteristic curve(ROC curve)was drawn.Results Compared with T2DM group and NC group,serum Hcy,IgG,α1MG and TRF levels in EDN and DN groups were significantly increased,urine TRF in DN group was further increased than that in EDN group,urine NAG was only increased in DN group.The area under ROC curve(95%CI),sensitivity and specificity of serum Hcy,urinary NAG,IgG,α1MG and TRF were 0.755(0.670-0.828),65.00%,83.30%;0.654(0.555-0.744),67.70%,66.20%;0.960(0.903-0.988),83.80%,95.90%;0.792(0.702-0.865),74.20%,78.30%;0.841(0.757-0.905),67.70%and 97.00%,respectively.The area under ROC curve of combined detection of urine IgG and TRF was 0.968(0.914-0.993),the diagnostic sensitivity was 87.10%,and the specificity was 93.20%.Conclusion Serum Hcy,urineα1MG and NAG are helpful in the diagnosis of DN.The combined detection of urinary TRF and IgG can improve the diagnostic efficiency of DN.

关 键 词：糖尿病肾病 同型半胱氨酸 转铁蛋白 免疫球蛋白G Α1微球蛋白 N-乙酰-Β-D氨基葡萄糖苷酶 

分 类 号：R587.1[医药卫生—内分泌] R446[医药卫生—内科学]