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胱抑素C、视黄醇结合蛋白联合游离脂肪酸在2型糖尿病肾病早期诊断中的临床价值
作者:杨栋民1  陈洪波2  刘占民3  陈宏1  李玉凤1 
单位:1. 秦皇岛市工人医院 检验科, 河北 秦皇岛 066200;
2. 中铁山桥集团医院 检验科, 河北 秦皇岛 066200;
3. 秦皇岛市骨科医院 检验科, 河北 秦皇岛 066200
关键词:胱抑素C 视黄醇结合蛋白 游离脂肪酸 2型糖尿病肾病 
分类号:R587.2
出版年·卷·期(页码):2018·46·第十二期(1344-1348)
摘要:

目的:探讨胱抑素C (Cys-C)、视黄醇结合蛋白(RBP)联合游离脂肪酸(NEFA)在2型糖尿病肾病(T2DN)早期诊断中的临床价值。方法:回顾性选取168例2型糖尿病(T2DM)患者为研究组,并选取41例门诊体检健康者为对照组,对比两组受试者血清Cys-C、RBP、NEFA水平的差异,以临床诊断为标准,受试者工作特征曲线(ROC)分析Cys-C、RBP、NEFA以及联合检测在T2DN早期诊断中的价值。结果:研究组患者血清Cys-C、RBP、NEFA、血清肌酐(Scr)、血尿酸(UA)、血尿素氮(BUN)平均水平分别为(1.5±0.6) mg·L-1、(71.5±16.4) mg·L-1、(2.6±1.4) mmol·L-1、(109.4±31.5)μmol·L-1、(324.6±59.7)μmol·L-1、(6.3±1.5) mmol·L-1,均显著高于对照组(P<0.05);血清Cys-C、RBP、NEFA、Scr、UA、BUN在不同亚组中差异有统计学意义(P<0.05),其中CDN (临床DN)组患者血清Cys-C、RBP、NEFA、Scr、UA、BUN指标均最高,其次为EDN (早期DN)组、SDM (单纯糖尿病)组,但EDN组、SDM组Scr、UA、BUN与对照组比较差异无统计学意义(P>0.05);CDN组患者血清Cys-C、RBP、NEFA阳性率最高,其次为EDN组、SDM组,联合检测血清Cys-C、RBP、NEFA阳性率高于单独检测;Cys-C、RBP、NEFA和联合检测诊断T2DN的灵敏度、特异度分别为63.4%、72.5%,70.2%、75.4%,69.5%、76.3%,86.3%、89.5%,Cys-C、RBP、NEFA和联合检测诊断T2DN的线下面积分别为0.602(95%CI 0.532~6.294)、0.683(95%CI 0.168~5.380)、0.723(95%CI 0.168~5.380)、0.883(95%CI 0.168~5.380)。结论:Cys-C、RBP、NEFA在T2DN患者中明显高于正常人群,联合检测这3项指标有助于提高早期T2DN诊断正确率。

Objective: To explore the clinical value of cystatin C (Cys-C), retinol binding protein (RBP) and free fatty acid (NEFA) in the early diagnosis of type 2 diabetic nephropathy (T2DN). Methods: A total of 168 patients with T2DM were selected as the study group, and 41 healthy persons with out-patient check-up were selected as the control group.The serum levels of Cys-C, RBP and NEFA were compared between the two groups. ROC curve was used to analyze the value of Cys-C, RBP, NEFA and joint detection in early diagnosis of T2DN. Results: The mean levels of serum Cys-C, RBP, NEFA, serum creatinine (Scr), serum uric acid (UA), blood urea nitrogen (BUN) in the study groupwere (1.5±0.6) mg·L-1, (71.5±16.4) mg·L-1, (2.6±1.4) mmol·L-1, (109.4±31.5) μmol·L-1, (324.6±59.7) μmol·L-1, (6.3±1.5) mmol·L-1, respectively, which were significantly higher than those in the control group(P<0.05).There were significant differences in serum Cys-C, RBP, NEFA, Scr, UA and BUN in different DN groups (P<0.05).The serum Cys-C, RBP, NEFA, Scr, UA and BUN were the highest in CDN group,followed by EDN group and SDM group. There was no difference in Scr, UA and BUN among EDN group, SDM group and control group (P>0.05).The positive rate of serum Cys-C, RBP and NEFA in CDN groupwas the highest, followed by EDN group and SDM group.The positive rate of combined detection of serum Cys-C, RBP and NEFA was higher than that of separate detection.The sensitivity and specificity of Cys-C, RBP, NEFA and combined detection for diagnosis of T2DN were 63.4%, 72.5%; 70.2%, 75.4%; 69.5%, 76.3%; 86.3%, 89.5%; respectively.The AUC of Cys-C, RBP, NEFA and combined detection for diagnosis of T2DN were 0.602 (95% CI 0.532-6.294), 0.683 (95% CI 0.168-5.380), 0.723 (95% CI 0.168-5.380), 0.883 (95% CI 0.168-5.380), respectively. Conclusion: Cys-C, RBP and NEFA are significantly higher in patients with T2DN than in normal people. Combined detection of these three indicators canimprove the accuracy of early diagnosis of T2DN.

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