摘要
目的探讨血清蛋白电泳(α2+β)/白蛋白(Alb)比值在糖尿病肾脏疾病早期筛查中的应用及其联合血清胱抑素C(CysC)对糖尿病肾脏疾病早期诊断的临床价值。方法选取2016年1月至2017年7月在我院就诊的2型糖尿病患者70例,根据尿微量白蛋白/尿肌酐比值(ACR)分为正常白蛋白尿组、早期糖尿病肾脏疾病组各35例,选取同期健康体检人员35例为对照组。比较各实验组血清蛋白电泳图谱、肾小球滤过率(eGFR)、血清肌酐(CREA)、α1微球蛋白(α1-MG)、β2微球蛋白(β2-MG)、CysC水平及血清蛋白电泳(α2+β)/Alb比值,并应用ROC曲线评估各指标诊断价值。结果随着糖尿病患者的尿ACR水平增高,血清蛋白电泳图谱发生明显改变,(α2+β)/Alb比值在各实验组间比较差异均有统计学意义(P<0.01)。ROC曲线分析显示,(α2+β)/Alb在区分早期糖尿病肾脏疾病与对照组、正常白蛋白尿组的AUC为0.860,Cut-off值为0.32时,灵敏度91.4%,特异度75.7%,优于eGFR、CREA、α1-MG、β2-MG、CysC;联合(α2+β)/Alb与CysC对糖尿病肾脏疾病早期诊断的AUC为0.911,灵敏度91.4%,特异度82.9%,诊断价值值得肯定。结论糖尿病肾脏疾病早期血清蛋白组份已发生改变,(α2+β)/Alb比值对糖尿病肾脏疾病的早期筛检具有一定的临床意义,联合CysC有助于糖尿病肾脏疾病的早期诊断。
Objective To investigate the clinical value of serum protein electrophoresis(α2+β)/Alb ratio in the early screening of diabetic nephropathy and its combination with serum CysC for early diagnosis of diabetic nephropathy. Methods According to urinary microalbumin/creatinine ratio(ACR), a total of 70 patients with type 2 diabetes were divided into normal albuminuria group and early diabetic nephropathy group with 35 cases in each group.At the same time, a total of 35 subjects for health check were selected as a control group. The serum protein electrophoresis, estimated glomerular filtration rate(eGFR), serum CREA, α1-MG, β2-MG, CysC level and serum protein electrophoresis(α2+β)/Alb ratio were compared among experimental groups, and the diagnostic value of each index was evaluated by ROC curve. Results With the increase of ACR level in diabetic patients, serum protein electrophoresis changed significantly, there were significant differences among experient groups in(α2+β)/Alb ratio(P<0.01). ROC curve analysis showed that the AUC of(α2+β)/Alb ratio in differentiating microalbuminuria, controls and normal albuminuria was 0.860 with the sensitivity of 91.4% and the specificity of 75.7% in the optimal cut-off value of 0.32, superior to eGFR, CREA, α1-MG, β2-MG and CysC;The AUC of the combination of(α2+β)/Alb and CysC for diagnosis of early stage of diabetic kidney disease was 0.911 with the sensitivity of 91.4% and the specificity of 82.9%.Conclusion The serum protein components of diabetic nephropathy changed in the early stage. The(α2+β)/Alb ratio has certain clinical significance for early screening of diabetic nephropathy, and its combination with CysC is helpful in the early diagnosis of diabetic nephropathy.
作者
陈佳
徐华
Chen Jia;Xu Hua(Department of Geriatrics,Panjin Liaoyou Gemstone Flower Hospital,Panjin 124010,China;Department of Laboratory Medicine,Panjin Liaoyou Gemstone Flower Hospital,Panjin 124010,China)
出处
《临床荟萃》
CAS
2019年第9期814-818,共5页
Clinical Focus
关键词
糖尿病肾病
血蛋白电泳
早期诊断
diabetic nephropathies
blood protein electrophoresis
early diagnosis
