尿KIM-1、TG/Cys C和尿ACR在糖尿病早期肾损伤诊断中的应用价值  

Application Value of Urinary KIM-1,TG/Cys C and Urinary ACR in the Diagnosis of Early Renal Injury in Diabetic Patients

作　　者：李坤[1] 赵维丽[2] 张培 徐运强[1] 柴雪姣[4] 张婷婷 LI Kun;ZHAO Weili;ZHANG Pei;XU Yunqiang;CHAI Xuejiao;ZHANG Tingting(Department of Clinical Laboratory,the Second Hospital of Shijiazhuang City,Shijiazhuang 050000,China;Hebei Key Laboratory of Basic Medicine for Diabetes,the Second Hospital of Shijiazhuang City,Shijiazhuang 050000,China;Diabetes Detection Center,the Second Hospital of Shijiazhuang City,Shijiazhuang 050000,China;Department of Science and Education,the Second Hospital of Shijiazhuang City,Shijiazhuang 050000,China;Department of Endocrinology,the Second Hospital of Shijiazhuang City,Shijiazhuang 050000,China)

机构地区：[1]石家庄市第二医院检验科,石家庄050051 [2]石家庄市第二医院、河北省糖尿病基础医学研究重点实验室,石家庄050051 [3]石家庄市第二医院糖尿病检测中心,石家庄050051 [4]石家庄市第二医院科教科,石家庄050051 [5]石家庄市第二医院内分泌科,石家庄050051

出　　处：《临床误诊误治》2024年第21期28-34,共7页Clinical Misdiagnosis & Mistherapy

基　　金：2022年度河北省医学科学研究课题计划(20221654)。

摘　　要：目的探讨尿肾损伤分子-1(KIM-1)、三酰甘油/胱抑素C(TG/Cys C)与尿微量白蛋白与尿肌酐比值(ACR)联合对糖尿病早期肾损伤患者的诊断价值,为避免临床延误诊断提供参考。方法将2020年1月至2023年12月收治的糖尿病早期肾损伤患者200例作为肾损伤组,按4∶1匹配原则选取糖尿病不伴肾损伤患者50例作为对照组。统计2组一般资料、尿KIM-1、TG/Cys C、尿ACR,分析肾损伤组尿KIM-1、TG/Cys C与尿ACR相关性;多因素logistic回归分析尿KIM-1、TG/Cys C对糖尿病早期肾损伤的影响,分析尿KIM-1、TG/Cys C、尿ACR对糖尿病早期肾损伤诊断价值。结果肾损伤组高血压病患者占比、糖化血红蛋白高于对照组,病程长于对照组(P<0.05,P<0.01);肾损伤组尿KIM-1、尿ACR高于对照组,TG/Cys C低于对照组(P<0.01);肾损伤组尿KIM-1与尿ACR呈正相关(r=0.749,P<0.001),TG/Cys C与尿ACR呈负相关(r=-0.693,P<0.001);尿KIM-1、TG/Cys C是糖尿病早期肾损伤的独立影响因素(P<0.01);尿KIM-1+TG/Cys C+尿ACR联合诊断糖尿病早期肾损伤的曲线下面积大于尿KIM-1+TG/Cys C、尿KIM-1+尿ACR、TG/Cys C+尿ACR。结论糖尿病早期肾损伤患者尿KIM-1、TG/Cys C与尿ACR密切相关,联合检测可明显提高糖尿病早期肾损伤的诊断效能。Objective To investigate the diagnostic value of urinary kidney injury molecular-1(KIM-1),triglyceride/cystatin C(TG/Cys C)and urinary microalbumin/creatinine ratio(ACR)in diabetic patients with early kidney injury,so as to provide reference for avoiding clinical delay in diagnosis.Methods In total,200 diabetic patients with early kidney injury admitted from January 2020 to December 2023 were selected as kidney injury group,and 50 diabetic patients without kidney injury were selected as control group according to the 4∶1 matching principle.The general data,urinary KIM-1,TG/Cys C and urinary ACR of the two groups were analyzed,and the correlation between urinary KIM-1,TG/Cys C and urinary ACR in the renal injury group was analyzed.Multivariate logistic regression analysis was conducted to analyze the effects of urinary KIM-1 and TG/Cys C on the early renal injury of diabetic patients,and to analyze the diagnostic value of urinary KIM-1,TG/Cys C and urinary ACR in the early renal injury of diabetic patients.Results The proportion of hypertensive patients and HBA1c in renal injury group were higher than those in control group,and the disease course was longer than that in control group(P<0.05,P<0.01).Urine KIM-1 and urinary ACR in renal injury group were higher than those in control group,while TG/Cys C was lower than that in control group(P<0.01).Urinary KIM-1 was positively correlated with urinary ACR in renal injury group(r=0.749,P<0.001),while TG/Cys C was negatively correlated with urinary ACR(r=-0.693,P<0.001).Urinary KIM-1 and TG/Cys C were independent influencing factors of early renal injury in diabetic patients(P<0.01).The area under the curve of the combination of KIM-1+TG/Cys C and urinary ACR in the diagnosis of early kidney injury in diabetic patients was greater than that of urinary KIM-1+TG/Cys C,urinary KIM-1+urinary ACR,TG/Cys C+urinary ACR.Conclusion Urinary KIM-1,TG/Cys C are closely related to urinary ACR in diabetic patients with early kidney injury,and the combined detection can significantl

关 键 词：糖尿病肾病 尿肾损伤分子-1 三酰甘油/胱抑素C 尿微量白蛋白与尿肌酐比值 糖化血红蛋白 早期诊断 曲线下面积 

分 类 号：R587.24[医药卫生—内分泌]