血清中性粒细胞明胶酶相关脂质运载蛋白、胱抑素-C和尿酸检测在糖尿病肾病早期诊断中的应用价值  

Value of serum neutrophils gelatinase-associated lipocalin,cystatin-C,and uric acid in the early diagnosis of diabetic nephropathy

作　　者：张佳思 邹春波 卢宇[2] 陈茜 张伟亚 何姣姣 杨淑芳[2] ZHANG Jia-si;ZOU Chun-bo;LU Yu;CHEN Xi;ZHANG Wei-ya;HE Jiao-jiao;YANG Shu-fang(Dalian Medical University,Dalian 116000,Liaoning,CHINA;Department of Endocrinology,Taizhou People's Hospital,Taizhou 225300,Jiangsu,CHINA;Department of Nephrology,Taizhou People's Hospital,Taizhou 225300,Jiangsu,CHINA)

机构地区：[1]大连医科大学,辽宁大连116000 [2]泰州市人民医院内分泌科,江苏泰州225300 [3]泰州市人民医院肾内科,江苏泰州225300

出　　处：《海南医学》2021年第4期420-424,共5页Hainan Medical Journal

基　　金：江苏省泰州市人民医院临床青年技术人才诊疗新技术项目(编号:ZL201706)。

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)和尿酸(UA)检测在糖尿病肾病(DN)早期诊断中的应用价值。方法回顾性分析2017年1月至2018年12月在泰州市人民医院确诊的193例2型糖尿病(T2DM)患者的临床资料,根据尿微量白蛋白排泄率(UAER)分为正常白蛋白尿(NA)组65例,微量白蛋白尿(MA)组66例和临床肾病(CN)组62例。检测并比较三组患者的血清NGAL、Cys-C和UA水平。采用Pearson直线相关、多元逐步回归及Logistic回归分析各指标与DN的关系,采用受试者工作特征(ROC)曲线分析各指标诊断DN的诊断效能。结果 NA组患者的NGAL、Cys-C、UA水平分别为49.83 (25.79,66.84) ng/mL、(0.93±0.17) mg/L、(301.37±75.02)μmoL/L,MA组分别为81.56 (64.20,100.71) ng/mL、(1.06±0.32) mg/L、(305.77±70.34)μmo L/L,CN组分别为158.59 (104.97,221.18) ng/mL、(1.89±0.77) mg/L,(375.00±115.87)μmoL/L,多组间比较差异均有统计学意义(P<0.05),但与NA组相比,MA组中只有NGAL水平明显升高,差异有统计学意义(P<0.05),而Cys-c和UA组间比较差异无统计学意义(P>0.05);Pearson相关分析结果显示,血清NGAL、Cys-C、UA与UAER、尿素氮(BUN)、肌酐(SCr)均呈正相关(r=0.502、0.414、0.417;r=0.574、0.421、0.480;r=0.414、0.421、0.567),与肾小球滤过率(eGFR)呈负相关(r=-0.360、-0.420、-0.430,P<0.05);多元逐步回归分析结果显示,NGAL、Cys-C、甘油三脂(TG)、低密度脂蛋白(LDL-C)是UAER的影响因素(P<0.05);Logistic回归分析表明,NGAL和Cys-C是早期DN的独立危险因素(P<0.05);UA、Cys-C、NGAL、NGAL+UA、NGAL+Cys-C、NGAL+Cys-C+UA诊断早期DN的ROC曲线下面积分别为0.608、0.724、0.873、0.871、0.889、0.890,单项检测时NGAL敏感度高(79.8%),Cys-C特异性高(98.5%),三项联合检测时诊断效能最大(AUC=0.890)。结论血清NGAL、Cys-C和UA均可反映糖尿病患者肾损伤的程度,但只有NGAL能够早期诊断及评估DN。NGAL是DN早期稳定的独立危险因�Objective To evaluate the role of serum neutrophils gelatinase-associated lipocalin(NGAL),cystatin-C(Cys-C),and uric acid(UA)in the early diagnosis of diabetic nephropathy(DN).Methods The clinical data of 193 cases with type 2 diabetes mellitus(T2DM)confirmed in Taizhou People's Hospital from January 2017 to December 2018 were retrospectively analyzed.According to the urinary albumin excretion rate(UAER),those patients were classified into normal albuminuria(NA)group(n=65),microalbuminuria(MA)group(n=66),and clinical nephropathy(CN)group(n=62).Serum NGAL,Cys-C,and UA levels were measured and compared among the three groups.Pearson's linear analysis,multiple regression analysis,and logistic regression analysis were used to analyze the association between each index and DN.ROC curve was used to analyze the diagnostic efficiency for DN.Results The mean values of NGAL,Cys-C,and UA were 49.83(25.79,66.84)ng/mL,(0.93±0.17)mg/L,(301.37±75.02)μmoL/L in NA group,81.56(64.20,100.71)ng/mL,(1.06±0.32)mg/L,(305.77±70.34)μmoL/L in MA group,and 158.59(104.97,221.18)ng/mL,(1.89±0.77)mg/L,and(375.00±115.87)μmoL/L in CN group,respectively;the differences were statistically significant(P<0.05).However,compared with the NA group,only NGAL level was significantly increased in the MA group(P<0.05),while there was no significant difference for Cys-C and UA(P>0.05).Pearson's linear analysis found that the serum NGAL,Cys-C,and UA levels were positively correlated with UAER,urea nitrogen(BUN),creatinine(SCr)(r=0.502,0.414,0.417;r=0.574,0.421,0.480;r=0.414,0.421,0.567),while negatively with eGFR(r=-0.360,-0.420,-0.430),P<0.05.The NGAL,Cys-C,triglyceride(TG),and low density lipoprotein-C(LDL-C)were significantly related to UAER based on multiple regression analysis(P<0.05).Logistic regression analysis showed that NGAL and Cys-C were independent risk factors for early DN(P<0.05).The area under the ROC curve for UA,Cys-C,NGAL,NGAL+UA,NGAL+Cys-C,and NGAL+Cys-C+UA in early DN were 0608,0.724,0.873,0.871,0.889,0.890,respectively.The sin

关 键 词：糖尿病肾病 中性粒细胞明胶酶相关性脂质运载蛋白 胱抑素-C 尿酸 2型糖尿病 尿微量白蛋白排泄率 

分 类 号：R587.2[医药卫生—内分泌]