血清胱抑素C和尿NAG联合检测在糖尿病肾病早期诊断中的应用  

Application of combined detection of serum cystatin C and urinary NAG in early diagnosis of diabetic nephropathy

作　　者：崔红萍 赵滢[2] 黄松苓 吴浩能 Cui Hongping;Zhao Ying;Huang Songling;Wu Haoneng(Department of Clinical Laboratory,Qujing Second People's Hospital,Qujing 655000,Yunnan,China;Department of Clinical Laboratory,the First Affiliated Hospital of Kunming Medical University,Kunming 650000,Yunnan,China)

机构地区：[1]云南省曲靖市第二人民医院检验科,云南曲靖655000 [2]昆明医科大学第一附属医院检验科,云南昆明650000

出　　处：《实用检验医师杂志》2023年第4期364-367,共4页Chinese Journal of Clinical Pathologist

摘　　要：目的探讨血清胱抑素C(CysC)和尿N-乙酰-β-D氨基葡萄糖苷酶(NAG)联合检测在糖尿病肾病早期诊断中的应用价值。方法选择2023年1—6月在昆明医科大学第一附属医院内分泌科就诊的476例2型糖尿病患者作为研究对象,根据尿白蛋白(ALB)/肌酐(Cr)比值(UACR)水平不同将患者分为无蛋白尿组(UACR<30 mg/g Cr;329例)、微量白蛋白尿组(30 mg/g Cr≤UACR<300 mg/g Cr;107例)和大量蛋白尿组(UACR≥300 mg/g Cr;40例)。使用全自动生化分析仪,采用胶乳凝集法检测血清CysC,2-氯-4硝基苯-N-乙酰-β-D-氨基葡萄糖苷底物法检测尿NAG,免疫比浊法检测ALB,酶法检测Cr水平。绘制受试者工作特征曲线(ROC曲线)并计算ROC曲线下面积(AUC),考察血清CysC和尿NAG单独与联合检测对糖尿病肾病的诊断效能。结果无蛋白尿组的CysC、尿NAG水平与对照组比较差异均无统计学意义;大量蛋白尿组的CysC和尿NAG水平均明显高于微量白蛋白尿组、无蛋白尿组和对照组[CysC(mg/L):1.79±0.76比1.21±0.78、0.83±0.23、0.79±0.13,尿NAG(U/L):21.34±15.75比15.61±13.01、11.80±8.78、10.26±5.43,均P<0.05];且微量白蛋白尿组的CysC和尿NAG水平均明显高于无蛋白尿组和对照组(均P<0.05)。ROC曲线分析显示,血清CysC和尿NAG联合检测对糖尿病肾病早期诊断的AUC为0.998,95%可信区间(95%CI)为0.996~1.000,明显高于血清CysC和尿NAG单独检测(AUC分别为0.676、0.608,95%CI分别为0.614~0.737、0.547~0.670)。结论各组受检者血清CysC、尿NAG水平有明显差异,且与病情严重程度有关;血清CysC可作为糖尿病肾病的诊断标志物,但不具备早期诊断效能;尿NAG可作为糖尿病肾病早期诊断的血清标志物,两项指标联合检测能提高糖尿病肾病的早期诊断效能。Objective To investigate the application value of combined detection of serum cystatin C(CysC)and urinary N-acetyl-β-D-glucosidase(NAG)in the early diagnosis of diabetic nephropathy.Methods A total of 476 patients with type 2 diabetes mellitus in endocrinology department of the First Affiliated Hospital of Kunming Medical University from January to June 2023 were selected as research objects.According to different levels of urinary albumin(ALB)/creatinine(Cr)ratio(UACR),the patients were divided into non proteinuria group(UACR<30 mg/g Cr;329 cases),microalbuminuria group(30 mg/g Cr≤UACR<300 mg/g Cr;107 cases)and massive proteinuria group(UACR≥300 mg/g Cr;40 cases).Using a fully automated biochemical analyzer,the serum level of CysC was detected using latex agglutination method,urine NAG was detected using 2-chloro-4-nitrobenzene-N-acetyl-β-D-glucosamine substrate method,ALB was detected using immunoassay,and Cr was detected using enzyme method.The receiver operator characteristic(ROC)curve was drawn and the area under ROC curve(AUC)was calculated to investigate the diagnostic efficacy of serum CysC and urine NAG single and combined detection for diabetes nephropathy.Results There was no significant difference in the levels of CysC and urinary NAG between non proteinuria group and control group.The levels of CysC and urinary NAG in massive proteinuria group were significantly higher than those in microalbuminuria group,non proteinuria group and control group[CysC(mg/L):1.79±0.76 vs.1.21±0.778,0.83±0.23,0.79±0.13,urinary NAG(U/L):21.34±15.75 vs.15.61±13.01,11.80±8.78,10.26±5.43,all P<0.05],and the levels of CysC and urinary NAG in microalbuminuria group were significantly higher than those in non albuminuria group and control group(both P<0.05).ROC curve analysis showed that the AUC of combined detection of serum CysC and urine NAG for early diagnosis of diabetes nephropathy was 0.998,and 95%confidence interval(95%CI)was 0.996-1.000,which was significantly higher than those by serum CysC and urine NAG

关 键 词：胱抑素C N-乙酰-Β-D氨基葡萄糖苷酶 尿白蛋白/肌酐比值 糖尿病肾病 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学] R446.11[医药卫生—临床医学]