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尿微量白蛋白、β2微球蛋白、血清胱抑素C联合检测对早期糖尿病肾病的诊断价值

ISSN号：1006-0189
期刊名称：《名作欣赏：中旬》
时间：0
分类：R587.2[医药卫生—内分泌;医药卫生—临床医学;医药卫生—内科学]
作者机构：南方医科大学附属佛山医院,广东佛山528000
相关基金：佛山市医学科研基金项目（编号2015313）;佛山市医学重点专科培育项目资助（Fspy3-2015022）

关键词：尿微量白蛋白, Β2微球蛋白, 血清胱抑素C, 早期糖尿病肾病, 联合检测, Microalbumin, β2-microglobulin, Cystatin C, Early diabetic nephropathy, combined detection

中文摘要：

目的：探讨尿微量白蛋白（mALB）、β2微球蛋白（p2-MG）、血清胱抑素C（Cys—C）联合检测对早期糖尿病肾病（DN）的诊断价值。方法：研究对象来自2014年8月到2015年8月佛山市第二人民医院内分泌科门诊初诊患者，通过病史、症状和查体拟诊为疑似糖尿病患者。再采用诊断金标准将疑似患者（研究对象）确诊分为DN（77）例及非DN（90）例，所有对象均采用全自动生化仪器法检测尿mALB、尿B2-MG及血清Cys—C。采用Roc曲线和诊断价值四格表计算诊断价值性能指标。结果：DN组mALB、β2-MG、Cys—C水平（分别为4．86±1．61、6．13±1．30和7．23±O．42）较非DN组（分别为2．62±1．04、5．64±1．04和6．86±0．31）显著升高（P〈0．05），单一指标InALB、β2-MG和Cys—C诊断DN的灵敏度分别为75．3％、50．6％和88．3％。单一指标mALB、β2-MG和Cys—C诊断DN的特异度分别为90．0％、76．7％和45．6％。2指标并联中，mALB＋Cys—C灵敏度最高，为94．8％；2指标串联中，mALB＋β2-MG特异性最高，为97．8％。3指标并联灵敏度97．4％，漏诊率2．6％。3指标串联特异性98．9％，误诊率1．1％。结论：在目前所选择研究指标中，mALB／β2-MG／Cys—C并联是DN最佳筛查方案。考虑到检测成本，mALB＋β2-MG串联是最佳确诊方案。

英文摘要：

Objective ： To discuss the diagnostic value of microalbumin, β2-microglobulin, and cystatin C combinations in early diabetic nephropathy（DN）. Methods ： To select the Endocrinology outpatient at their first visit to The Second People＇s Hospital of Foshan from August 2014 to August 2015. Suspicious DN patients were diagnosed by history, symptoms and physical check,and suspicious DN patients were classified DN patients （n=77） and non-DN patients （n=90） following the diagnostic gold criteria.The concentrations of Urine mALB, Urine β2-MG and Cys-C were determinded by fully automatic biochemical instrument method. The assessed parameters of diagnostic value were measured by ROC curve and the fourfold table of diagnostic value.Results ： The concentration 0fUrine mALB, Urine β2-MG and Cys-C of DN patients （4.86 ± 1.61,6.13 ± 1.30 and 7.23 ± 0.42） was significantly higher（P〈0.05） than that of non-DN patients（2.62 ± 1.04, 5.64 ± 1.04 end 6.86± 0.31 ）.The diagnostic sensitivity of Urine mALB, Urine β2-MG and Cys-C for diagnosing DN were 90.0%, 76.7% and 45.6%, respectivly.The diagnostic specificity of Urine mALB, Urine β2-MG and Cys-C for diagnosing DN were 90.0%, 76.7% and45.6%, respectivly. In two Parallel test combinations, the diagnostic sensitivity of mALB＋Cys-C was the highest（94.8%） and in two series test combinations, the diagnostic specificity ofmALB＋ β2-MG was the highest （97.8%）. The diagnostic sensitivity was 97.4% and the false negative rate was 2.6% in three Parallel test combinations. The diagnostic specificity was 98.9% and false positive rate was 1.1% in three series test combinations. Conclusions ： In the current study, parallel test combinations of mALB/β2-MG/Cys-C was the most efficient as performance index of early diabetic nephropathy. Considering the detection cost, series test combinations of rnALB ＋ β2-MG was the most efficient as diagnostic method.

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