摘要
目的 探讨血清β2-微球蛋白(β2-MG)、尿β2-MG与糖化血红蛋白(HbA1c)联合检测对早期糖尿病肾病(DKD)的诊断价值,为早期DKD筛查与干预提供循证依据。方法 选取2023-01-01-12-31沧县医院诊治的116例2型糖尿病(T2DM)患者为研究对象,依据《中国糖尿病肾脏病防治指南(2021年版)》标准将患者分为早期DKD组(42例)与单纯T2DM组(74例)。检测2组患者血清β2-MG、尿β2-MG、HbA1c及其他肾功能指标[空腹血糖(FBG)、血清肌酐(Scr)、血尿素氮(BUN)、血尿酸(BUA)];采用logistic回归模型构建联合诊断方程,通过受试者工作特征(ROC)曲线分析各指标及联合检测的诊断效能,利用Kappa检验评估联合诊断与金标准[肾小球滤过率(eGFR)、尿白蛋白/肌酐比值(UACR)]的一致性,结合决策曲线分析临床净获益率。结果 116例T2DM患者中早期DKD发生率为36.21%(42/116);早期DKD组血清β2-MG[(2.53±0.46)mg/L]、尿β2-MG[(0.42±0.08)mg/L]、HbA1c[(7.83±1.27)%]水平均高于单纯T2DM组[分别为(1.88±0.35)mg/L、(0.28±0.06)mg/L、(6.83±0.85)%],差异均有统计学意义,t值分别为8.461、11.169、5.071,均P<0.001。2组FBG、Scr、BUN、BUA水平比较,差异无统计学意义,均P>0.05。logistic回归分析显示,血清β2-MG(P=0.003)、尿β2-MG(P=0.005)及HbA1c(P=0.013)水平升高对早期DKD的诊断具有统计学意义。血清β2-MG、尿β2-MG、HbA1c联合诊断的曲线下面积达0.996(95%CI:0.989~1.000),灵敏度0.976、特异度0.905、约登指数0.881,均优于单一指标;联合诊断与金标准(eGFR、UACR)具有完全一致性(Kappa=0.855,P<0.05);决策曲线显示,联合诊断的临床净获益率为36.20%,覆盖单一指标净获益范围。结论 血清β2-MG、尿β2-MG与HbA1c联合检测可显著提高早期DKD的诊断效能,具有较高的灵敏度、特异度及临床净获益,可作为早期DKD筛查的有效手段。
Objective To evaluate the diagnostic value of combined detection of serumβ2-microglobulin(β2-MG),urinaryβ2-MG,and glycated hemoglobin(HbA1c)for early diabetic kidney disease(DKD)and provide evidence-based support for early screening and intervention.Methods A total of 116 patients with type 2 diabetes mellitus(T2DM)treated at Cangxian Hospital from January 1 to December 31,2023,were enrolled.According to the Chinese Guidelines for the Prevention and Treatment of Diabetic Kidney Disease(2021 Edition),patients were divided into an early DKD group(n=42)and a T2DM-only group(n=74).Serumβ2-MG,urinaryβ2-MG,HbA1c,and other renal function indicators[fasting blood glucose(FBG),serum creatinine(Scr),blood urea nitrogen(BUN),and blood uric acid(BUA)]were measured.A logistic regression model was used to construct ajoint diagnostic equation.The diagnostic efficacy of individ-ual and combined indicators was analyzed using receiver operating characteristic(ROC)curves.The consistency between the combined diagnosis and the gold standard[estimated glomerular filtration rate(eGFR)and urinary albumin-to-creati-nine ratio(UACR)]was assessed by using the Kappa test,and the clinical net benefit rate was evaluated via decision curve analysis.Results The incidence of early DKD among the 116 T2DM patients was 36.21%(42/116).The early DKD group exhibited higher levels of serumβ2-MG[(2.53±0.46)mg/L],urinaryβ2-MG[(0.42±0.08)mg/L],and HbA1c[(7.83±1.27)%]compared to the T2DM-only group[(1.88±0.35)mg/L,(0.28±0.06)mg/L,and(6.83±0.85)%,respectively],with statistically significant differences(t values were 8.461,11.169,and 5.071,all P<0.001).No significant differences were observed in FBG,Scr,BUN,or BUA levels(all P>0.05).Logistic regression analysis showed that elevated levels of serumβ2-MG(P=0.003),urinaryβ2-MG(P=0.005),and HbA1c(P=0.013)were statistically significant for the diagnosis of early-stage DKD.The combined detection of serumβ2-MG,urinaryβ2-MG,and HbA1c achieved an area under the curve of 0.996(95%CI:0.989-1.000),sensitivity of 0.976,specificity of 0.905,and Youden's index of 0.881,outperforming individual indicators.The combined diagnosis showed complete con-sistency with the gold standard(eGFR and UACR)(Kappa=0.855,P<0.05).Decision curve analysis revealed a clini-cal net benefit rate of 36.20%,covering the net benefit range of single indicators.Conclusions Combined detection of ser-umβ2-MG,urinaryβ2-MG,and HbA1c significantly improves the diagnostic efficacy for early DKD,demonstrating high sensitivity,specificity,and clinical net benefit.It may serve as an effective screening tool for early DKD.
作者
贾晓彤
蒲晓伟
李静
刘喜双
张立东
JIA Xiaotong;PU Xiaowei;LI Jing;LIU Xishuang;ZHANG Lidong(Department of Clinical Laboratory,Cangxian Hospital,Cangzhou,Hebei O6looo,China)
出处
《社区医学杂志》
2025年第17期594-599,共6页
Journal Of Community Medicine
关键词
早期糖尿病肾病
Β2-微球蛋白
糖化血红蛋白
联合检测
诊断效能
early diabetic kidney disease
β2-microglobulin
glycated hemoglobin
combined detection
diagnostic efficacy
