老年糖尿病肾病病人血清6项指标检测水平与尿微量白蛋白的关系  

Study on the relationship between serum levels of 6 indicators and urinary microalbumin in elderly patients with diabetic nephropathy

作　　者：徐敏 李兴旺 高修银 卢海龙 杨紫旋 杨荣礼 XU Min;LI Xingwang;GAO Xiuyin;LU Hailong;YANG Zixuan;YANG Rongli(College of Graduate,,Xuzhou Medical University,Xuzhou,Jiangsu 221004,China;Department of General Medicine,Xuzhou Medical University,Xuzhou,Jiangsu 221004,China;Department of Geriatrics,,The Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221004,China;Department of Clinical Laboratory,The Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221004,China)

机构地区：[1]徐州医科大学研究生学院,江苏徐州221004 [2]徐州医科大学全科医学教研室,江苏徐州221004 [3]徐州医科大学附属医院老年医学科,江苏徐州221004 [4]徐州医科大学附属医院检验科,江苏徐州221004

出　　处：《安徽医药》2021年第11期2187-2191,共5页Anhui Medical and Pharmaceutical Journal

基　　金：江苏省徐州市科技计划项目(KC16SH078)。

摘　　要：目的探讨血清β2微球蛋白(β2-MG)、视黄醇结合蛋白(RBP)、转化生长因子-β1(TGF-β1)、中性粒细胞/淋巴细胞比值(NLR),胱抑素C(Cys-C)以及糖化血红蛋白(HbA1c)检测水平在老年糖尿病肾病(DN)人群中与尿微量白蛋白的关系。方法选取2018年5月至2020年5月徐州医科大学附属医院收治的老年2型糖尿病(T2DM)病人154例,按照尿微量白蛋白水平分为三组,A组尿微量白蛋白小于30 mg/L;B组尿微量白蛋白30~300 mg/L;C组尿微量白蛋白大于300 mg/L。同时选取51例健康体检者作为对照组,分别测定四组的β2-MG、RBP、TGF-β1、NLR,Cys-C以及HbA1c水平,应用ROC曲线和Pearson相关性分析判断各指标诊断效能。结果随着尿微量白蛋白的增加,β2-MG、RBP、TGF-β1、NLR、Cys-C、HbA1c水平逐渐升高。通过ROC曲线发现,β2-MG、RBP、TGF-β1、NLR、Cys-C、HbA1c诊断老年T2DM出现尿微量白蛋白的截断值分别为3.31 mg/L、63.22 mg/L、72.69µg/L、2.31、1.15 mg/L、7.50%。各指标联合检测时,敏感度和特异度均得到明显提高。从Pearson相关分析可以看出,上述6项指标与尿微量白蛋白均呈正相关关系。结论老年T2DM的β2-MG、RBP、TGF-β1、NLR、Cys-C、HbA1c水平随着尿微量白蛋白的出现及增加而升高,可作为早期发现DN的血清学标志,各指标联合运用诊断老年T2DM肾功能损害的准确性明显提高。Objective To investigate the relationship between the levels of serumβ2 microglobulin(β2-MG),retinol binding protein(RBP),transforming growth factor-β1(TGF-β1),neutrophil/lymphocyte ratio(NLR),cystatin C(Cys-C),glycosylated hemoglobin(HbA1c)and urinary microalbumin in elderly patients with diabetic nephropathy(DN).Methods A total of 154 elderly patients with type 2 diabetes mellitus(T2DM)admitted to the Affiliated Hospital of Xuzhou Medical University from May 2018 to May 2020 were selected and assigned into three groups according to the level of urinary microalbumin.Group A:Urinary microalbumin was less than 30 mg/L;Group B:Urinary microalbumin was between 30 mg/L and 300 mg/L;Group C:Urinary microalbumin was more than 300 mg/L.At the same time,51 patients who underwent physical examination were selected as a control group,and the levels ofβ2-MG,RBP,TGF-β1,NLR,Cys-C and HbA1c in 4 groups were measured respectively.ROC curve and Pearson correlation analysis were used to determine the diagnostic efficacy of each indicator.Results The levels ofβ2-MG,RBP,TGF-β1,NLR,Cys-C and HbA1c increased with the increase of urinary microalbumin.ROC curve showed that the cutoff values of urinary microalbumin in the diagnosis of T2DM in the elderly were 3.31 mg/L,63.22 mg/L,72.69µg/L,2.31,1.15 mg/L and 7.50%,respectively.The sensitivity and specificity were im‐proved obviously when all indexes were tested together.Pearson correlation analysis showed that the 6 indexes above were positively correlated with urinary microalbumin.Conclusion The levels ofβ2-MG,RBP,TGF-β1,NLR,Cys-C and HbA1c in elderly patients with T2DM are increased with the occurrence of DN and the progression of renal damage,which can be used as serological markers for the early detection of diabetic nephropathy.The accuracy of the combined application of these indexes in the diagnosis of renal impairment in elderly patients with T2DM is significantly improved.

关 键 词：糖尿病肾病 视黄醇结合蛋白质类 血浆 老年人 2型糖尿病 血清学指标 尿微量白蛋白 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]