血清脂蛋白α、胱抑素-C和尿酸检测对早期糖尿病肾病的诊断价值

doi:10.3969/j.issn.1004-583X.2022.03.009

摘要/Abstract

摘要：

目的分析脂蛋白α[LP(α)]、血清胱抑素-C(Cys-C)和尿酸(UA)检验在早期糖尿病肾病(DN)诊断中的应用价值。方法回顾性分析2020年1月至2021年8月在葫芦岛市中心医院确诊的2型糖尿病(T2DM)患者150例,根据尿白蛋白肌酐比值(UACR)分组,即正常白蛋白尿(NA)组50例(UACR 0~3 mg/mmol),微量白蛋白尿(MA)组51例(UACR 3~29 mg/mmol)和临床白蛋白尿(CA)组49例(UACR>30 mg/mmol),检验并比较3组一般临床资料、相关临床指标及血清LP(α)、Cys-C和UA水平,采用Pearson直线相关及Logistic回归分析各指标与DN的关系,采用受试者工作特征(ROC)曲线评估各指标对DN 的诊断价值。结果 3组收缩压、舒张压差异有统计学意义(P<0.05);UACR、血肌酐(SCr)、肾小球滤过率(eGFR)、空腹血糖(FPG)、糖化血红蛋白(HbA₁c)、Cys-C、UA、LP(α)差异有统计学意义(P<0.05)。与NA组相比,MA组的LP(α)的水平升高最明显,差异有统计学意义(P<0.05)。Pearson相关性分析显示,血清Cys-C、UA、LP(α)与UACR、SCr均呈正相关,与eGFR呈负相关;Logistic回归分析表明,Cys-C和LP(α)是早期 DN 的独立危险因素(P<0.05);ROC曲线分析结果显示,血清Cys-C和LP(α)对早期DN有较高的的诊断价值。结论血清LP(α)、Cys-C和UA均可反映糖尿病患者肾损伤的程度,其中LP(α)和Cys-C是早期DN的独立危险因子,三者联合诊断准确度最高,对早期预测DN发生具有较高的诊断效能。

关键词: 糖尿病肾病, 脂蛋白α, 胱抑素-C, 尿酸, 2型糖尿病, 尿白蛋白肌酐比值

Abstract:

Objective To analyze the diagnostic value of serum lipoprotein (α)[LP(α)], cystatin-C (Cys-C) and uric acid (UA) on early diabetic nephropathy (DN). Methods In this retrospective analysis, 150 diagnosed type 2 diabetes mellitus (T2DM) patients admitted to Huludao Central Hospital from January 2020 to August 2021 were enrolled, according to urinary albumin/creatinine ratio (UACR), those patients were assigned into normal albuminuria (NA) group (n=50, UACR: 0~3 mg/mmol), microalbuminuria (MA) group (n=51, UACR: 3~29 mg/mmol), clinical albuminuria (CA) group (n=49, UACR>30 mg/mmol). The general clinical data, correlated clinical indexes, Serum LP(α), Cys-C, UA level were detected and compared among three groups. Pearson's correlation and Logistic regression analysis were used to analyze the correlation between each index and DN; receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of each index for DN.Results Among three groups, difference was statistically significant in the systolic blood pressure (SBP) and diastolic blood pressure (DBP) (P<0.05); there were significant differences in the serum creatine (SCr), estimated glomerular filtration rate (eGFR), fasting plasma glucose (FPG), glycosylated hemoglobin A₁c (HbA₁c), Cys-C, UA, LP(α) (P<0.05). LP(α) in MA group significantly increased when compared with NA group, with statistically significant difference (P<0.05). Pearson's correlation showed that serum Cys-C, UA, LP(α) were positively correlated with UACR and SCr, while negatively correlated with eGFR. Logistic regression analysis showed that the independent risk factors for early DN included Cys-C and LP(α). The results of ROC curve analysis showed that serum Cys-C and LP(α) had high diagnostic value for early DN. Conclusion Different degrees of renal damage in T2DM patients were reflected by Serum LP(α), Cys-C and UA, of which LP(α) and Cys-C being independent risk factors for early DN. The highest accuracy emerges in the combined of the three, with high diagnostic efficacy of prediction for early DN.

Key words: diabetic nephropathies, lipoprotein α, cystatin-C, uric acid, type 2 diabetes mellitus, urinary albumin/creatinine ratio

中图分类号:

R587.24

高士欣, 宋冰, 施克新. 血清脂蛋白α、胱抑素-C和尿酸检测对早期糖尿病肾病的诊断价值[J]. 临床荟萃, 2022, 37(3): 248-252.

Gao Shixin, Song Bing, Shi Kexin. Diagnosis value of serum lipoprotein α, cystatin-C and uric acid on early diabetic nephropathy[J]. Clinical Focus, 2022, 37(3): 248-252.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.03.009

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I3/248

图/表 6

参考文献 17

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指标	NA组(n=50)	MA组(n=51)	CA组(n=49)	F/χ²值	P值
性别[例(男/女)]	27/23	31/20	29/20	0.515	0.77
年龄(岁)	57.32±9.85	60.13±12.81	61.09±9.14	2.20	0.11
身高(cm)	165.44±13.79	168.17±8.25	167.96±7.65	1.46	0.23
体重(kg)	72.14±11.91	71.09±12.16	69.46±9.15	1.32	0.27
糖尿病病程(年)	7(3, 14)	10(4,18)	9(6,9)	2.17	0.34
高血压病程(年)	0(0,6)	0(0,8)	0(0,5)	0.53	0.77
身体质量指数BMI(kg/m²)	25.89±3.39	25.09±3.72	24.61±2.62	1.92	0.15
收缩压(mmHg)	129.5±15.14	134.4±18.37	158.32±24.36	46.01	0.00
舒张压(mmHg)	81.42±9.20	83.66±11.99	87.85±11.95	6.55	0.00

指标	NA组(n=50)	MA组(n=51)	CA组(n=49)	F/χ²值	P值
性别[例(男/女)]	27/23	31/20	29/20	0.515	0.77
年龄(岁)	57.32±9.85	60.13±12.81	61.09±9.14	2.20	0.11
身高(cm)	165.44±13.79	168.17±8.25	167.96±7.65	1.46	0.23
体重(kg)	72.14±11.91	71.09±12.16	69.46±9.15	1.32	0.27
糖尿病病程(年)	7(3, 14)	10(4,18)	9(6,9)	2.17	0.34
高血压病程(年)	0(0,6)	0(0,8)	0(0,5)	0.53	0.77
身体质量指数BMI(kg/m²)	25.89±3.39	25.09±3.72	24.61±2.62	1.92	0.15
收缩压(mmHg)	129.5±15.14	134.4±18.37	158.32±24.36	46.01	0.00
舒张压(mmHg)	81.42±9.20	83.66±11.99	87.85±11.95	6.55	0.00

指标	NA组(n=50)	MA组(n=51)	CA组(n=49)	F/χ²值	P值
UACR(mg/mmol)	0.89(0.52, 1.6725)	5.6(3.6,12.61)	70(44.175, 101.5)^*#	204.58	0.00
SCr(μmol/L)	66.49±15.36	67.24±15.87	381.36±150.9^*#	239.01	0.00
eGFR[ml/(min·1.73 m²)]	106.17±27.40	113.27±30.139	31.57±20.48^*#	329.50	0.00
FPG(mmol/L)	8.08(7.3,9.35)	9.12(7.61,12.89)	9.94(7.5,11.1)^*#	13.79	0.01
HbA₁c(%)	8.15(7.08,10)	9.6(7.8,11)	8.4(6.40,9.55)^*#	9.25	0.01
TG(mmol/L)	2.29±1.61	2.42±1.68	2.13±0.88	1.31	0.27
TC(mmol/L)	4.62±1.12	4.70±1.34	4.38±1.12	1.98	0.14
HDL-C(mmol/L)	1.01±0.27	0.99±0.30	0.97±0.25	0.52	0.60
LDL-C(mmol/L)	2.72±0.91	2.71±0.75	2.83±0.74	0.68	0.51
Cys-C(mg/L)	0.91±0.24	2.03±2.03	4.67±2.50^*#	67.64	0.00
UA(μmol/L)	291.72±3.06	318.86±96.059	415.71±142.82^*#	24.52	0.00
LP(α)(nmol/L)	8.05±3.06	57.83±14.47^*	139.71±47.00^*#	269.78	0.00

指标	NA组(n=50)	MA组(n=51)	CA组(n=49)	F/χ²值	P值
UACR(mg/mmol)	0.89(0.52, 1.6725)	5.6(3.6,12.61)	70(44.175, 101.5)^*#	204.58	0.00
SCr(μmol/L)	66.49±15.36	67.24±15.87	381.36±150.9^*#	239.01	0.00
eGFR[ml/(min·1.73 m²)]	106.17±27.40	113.27±30.139	31.57±20.48^*#	329.50	0.00
FPG(mmol/L)	8.08(7.3,9.35)	9.12(7.61,12.89)	9.94(7.5,11.1)^*#	13.79	0.01
HbA₁c(%)	8.15(7.08,10)	9.6(7.8,11)	8.4(6.40,9.55)^*#	9.25	0.01
TG(mmol/L)	2.29±1.61	2.42±1.68	2.13±0.88	1.31	0.27
TC(mmol/L)	4.62±1.12	4.70±1.34	4.38±1.12	1.98	0.14
HDL-C(mmol/L)	1.01±0.27	0.99±0.30	0.97±0.25	0.52	0.60
LDL-C(mmol/L)	2.72±0.91	2.71±0.75	2.83±0.74	0.68	0.51
Cys-C(mg/L)	0.91±0.24	2.03±2.03	4.67±2.50^*#	67.64	0.00
UA(μmol/L)	291.72±3.06	318.86±96.059	415.71±142.82^*#	24.52	0.00
LP(α)(nmol/L)	8.05±3.06	57.83±14.47^*	139.71±47.00^*#	269.78	0.00

指标	UACR	SCr	eGFR
Cys-C	0.204(0.012)	0.736(0.000)	-0.548(0.000)
UA	0.261(0.001)	0.377(0.000)	-0.460(0.000)
Lp(α)	0.455(0.000)	0.75(0.000)	-0.641(0.000)