2型糖尿病视网膜病变联合尿微量白蛋白/肌酐比值对糖尿病肾病的诊断价值  

Value of DR combined with urinary ACR in diagnosis of diabetic nephropathy

作　　者：胡威 陈光敏 胡雁 朱进[3] 曾薇 Hu Wei;Chen Guang-Min;Hu Yan;Zhu Jin;Zeng Wei(Department of Nephrotic and Urology,the University Town Hospital of Chongqing Medical University,Chongqing 401331,China;Department of Ophthalmology,the University Town Hospital of Chongqing Medical University,Chongqing 401331,China;Clinicopathological Diagnosis Center of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属大学城医院肾病泌尿中心,重庆401331 [2]重庆医科大学附属大学城医院眼科,重庆401331 [3]重庆医科大学临床病理诊断中心,重庆400016

出　　处：《解放军医学杂志》2021年第9期923-927,共5页Medical Journal of Chinese People's Liberation Army

基　　金：重庆医科大学附属大学城医院青苗计划(2019LC06)。

摘　　要：目的分析2型糖尿病患者视网膜病变联合尿微量白蛋白/肌酐比值(ACR)对糖尿病肾病(DKD)的诊断价值。方法回顾性分析2017年12月-2020年12月在重庆医科大学附属大学城医院肾病泌尿中心、内分泌科首次住院的212例2型糖尿病合并肾脏受损且行肾活检患者的临床资料。根据肾活检及眼底镜检查结果将患者分为3组:DKD+糖尿病视网膜病变(DR)组(n=96)、DKD+非糖尿病视网膜病变(non-DR)组(n=75)、非糖尿病肾病(non-DKD)+DR组(n=41)。比较各组一般资料和实验室检查指标,并分析DKD在不同程度DR分组中的发病率、DKD的危险因素及DR+ACR对DKD的诊断价值。结果与DKD+DR组比较,DKD+non-DR组、non-DKD+DR组血清肌酐(Scr)、ACR明显降低,估算肾小球滤过率(eGFR)明显升高,差异有统计学意义(P<0.05);且与DKD+DR组比较,non-DKD+DR组病程短,平均动脉压(MAP)、尿素氮(BUN)、胱抑素C(Cys-C)、24 h尿蛋白降低,血清白蛋白(ALB)升高,差异有统计学意义(P<0.05);DKD在增殖期视网膜病变(PDR)组的发病率明显高于非增殖期视网膜病变(NPDR)组,差异有统计学意义(χ^(2)=9.578,P=0.001)。Logistic回归分析结果显示,ACR、DR、PDR是DKD的独立危险因素,而高eGFR为保护因素(OR=0.92,P=0.004)。ROC曲线分析结果显示,PDR+ACR可有效诊断DKD,曲线下面积为0.88,而NPDR+ACR对DKD的诊断价值有限,曲线下面积仅为0.63。结论在2型糖尿病患者中,DR联合ACR对确诊DKD价值有限。Objective To analyze the clinical value of diabetic retinopathy(DR)indicators combined with urinary microalbumin/creatinine ratio(ACR)in diagnosis of diabetic kidney disease(DKD)for patients with type 2 diabetes.Methods The clinical data were retrospectively analyzed of 212 patients with type 2 diabetes mellitus complicated with kidney damage and firstly hospitalized and undergone renal biopsy in the Department of Nephropathy and Urology,the University Town Hospital of Chongqing Medical University during December 2017 to December 2020.According to the results of renal biopsy and ophthalmoscopy,all the subjects were assigned into DKD+DR group(n=96),DKD+non-DR group(n=75)and non-DKD+DR group(n=41).The general data and laboratory indexes of each group were collected and compared.The morbidity of DKD in different degrees of DR groups,risk factors for DKD and the diagnostic value of DR+ACR to DKD were analyzed.Results The levels of serum creatinine(Scr)and ACR were obviously lower,but the glomerulus filtering rate(eGFR)was markedly higher in DKD+non-DR group and non-DKD+DR group than in DKD+DR group with statistically significant difference(P<0.05);Compared with that in DKD+DR group,shorter disease course,decreased levels of mean arterial pressure(MAP),blood urea nitrogen(BUN),cystatin C(Cys-C)and 24 h urinary protein,and higher level of serum albumin(ALB)were in non-DKD+DR group with statistically significant difference(P<0.05);The morbidity ratio of DKD was obviously higher in proliferative diabetic retinopathy(PDR)group than in non-proliferative diabetic retinopathy(NPDR)group with significant difference(χ2=9.578,P=0.001).Logistic regression analysis showed that ACR,DR and PDR were the independent risk factors for DKD,while high eGFR was a protective factor(OR=0.92,P=0.004).ROC curve analysis revealed that PDR+ACR may effectively diagnose DKD with AUC of 0.88,while NPDR+ACR only have a limited diagnostic value for DKD with AUC of only 0.63.Conclusion DR combined with urinary ACR may contribute a limited value in d

关 键 词：2型糖尿病 糖尿病视网膜病变 尿微量白蛋白/肌酐比值 

分 类 号：R447[医药卫生—诊断学]