HbA1c和ACR及HE4联合检测在糖尿病肾病早期诊断中的意义  

Significance of combined detection of HbA1c,ACR,and HE4 in the early diagnosis of diabetic kidney disease

作　　者：王婷 伍格 李欢[1] 马林[1] WANG Ting;WU Ge;LI Huan;MA Lin(Department of Medical Laboratory,Sichuan Electric Power Hospital,Chengdu,Sichuan 610000,China)

机构地区：[1]四川电力医院医学检验科,四川成都610000

出　　处：《医药前沿》2025年第6期45-48,共4页Journal of Frontiers of Medicine

摘　　要：目的探讨糖化血红蛋白(HbA1c)、尿微量白蛋白/尿肌酐比值(ACR)、血清人附睾蛋白4(HE4)联合检测在糖尿病肾病(DKD)早期诊断中的意义。方法回顾性选取2022年3月-2024年3月四川电力医院收治的100例2型糖尿病(T2DM)患者,根据尿白蛋白排出率(UAER)将患者分为两组,UAER≥30 mg/d为DKD组(55例),UAER<30 mg/d为单纯T2DM组(45例);另选取本院同期50名健康体检者作为对照组。比较三组HbA1c、ACR、血清HE4水平;比较不同分期DKD患者的HbA1c、ACR、血清HE4水平;绘制受试者工作特征(ROC)曲线,比较三项指标单项及联合检测对DKD的诊断结果。结果单纯T2DM组患者的HbA1c、ACR、血清HE4水平高于对照组;DKD组患者HbA1c、ACR、血清HE4水平高于对照组、单纯T2DM组;2期DKD患者HbA1c、血清HE4水平高于1期;3期DKD患者HbA1c、ACR、血清HE4水平均高于1、2期,差异有统计学意义(P<0.05)。HbA1c、ACR、血清HE4联合检测ROC曲线下面积(AUC)值高于单项检测(Z=3.415,3.093,2.856;P<0.05)。结论HbA1c、ACR、血清HE4水平可作为诊断DKD的敏感指标,联合检测能提高诊断效能。Objective To explore the significance of combined detection of hemoglobin A1c(HbA1c),albumin-to-creatinine ratio(ACR),and serum human epididymis protein 4(HE4)in the early diagnosis of diabetic kidney disease(DKD).Methods A retrospective study was conducted on 100 patients with type 2 diabetes mellitus(T2DM)admitted to Sichuan Electric Power Hospital from March 2022 to March 2024.The patients were divided into two groups according to the urinary albumin excretion rate(UAER).Patients with UAER≥30 mg/d were assigned to the DKD group(n=55),and those with UAER<30 mg/d were assigned to the simple T2DM group(n=45).Additionally,50 healthy subjects who underwent physical examinations at the same hospital during the same period were selected as the control group.The levels of HbA1c,ACR,and serum HE4 were compared among the three groups.The levels of HbA1c,ACR,and serum HE4 in DKD patients at different stages were compared.The diagnostic results of DKD by single and combined detection of the three indicators were compared by drawing receiver operating characteristic(ROC)curves.Results The levels of HbA1c,ACR,and serum HE4 in patients of the simple T2DM group were higher than those in the control group;the levels of HbA1c,ACR,and serum HE4 in patients of the DKD group were higher than those in the control group and the simple T2DM group;the levels of HbA1c and serum HE4 in DKD patients at stage 2 were higher than those at stage 1;the levels of HbA1c,ACR,and serum HE4 in DKD patients at stage 3 were higher than those at stages 1 and 2,the differences were statistically significant(P<0.05).The area under the ROC curve(AUC)value of the combined detection of HbA1c,ACR,and serum HE4 was higher than that of single detection(Z=3.415,3.093,2.856,P<0.05).Conclusions The levels of HbA1c,ACR,and serum HE4 can be used as sensitive indicators for the diagnosis of DKD.Combined detection can improve the diagnostic efficiency.

关 键 词：糖化血红蛋白 尿微量白蛋白与尿肌酐比值 人附睾蛋白4 糖尿病肾病 2型糖尿病 

分 类 号：R587[医药卫生—内分泌]