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目的探讨联合检测同型半胱氨酸(Hcy)与血清胱抑素C(Cys-C)在早期糖尿病肾病诊断中的临床价值。方法选择2型糖尿病患者94例,依据尿微量白蛋白排泄率(UAER),分为单纯糖尿病组(SDM组)62例:UAER<30 mg/24 h;早期糖尿病肾病组(EDN组)32例:UAER 30 mg/24 h~300 mg/24 h。另选取同期体检的健康志愿者40例。比较各组实验室指标,受试者工作曲线(ROC)计算Hcy、Cys-C诊断早期糖尿病肾病的临界值。结果 EDN组Hcy、Cys-C水平高于SDM组、NC组,差异有统计学意义(P<0.05)。在Hcy临界值取13.55μmol/L时,诊断早期糖尿病肾病的敏感度为87.5%、特异度为77.42%、诊断指数达到最大值为0.649 2,AUC为0.872。在Cys-C临界值取1.3 mg/L时,诊断早期糖尿病肾病的敏感度为84.38%,特异度为75.81%,诊断指数达到最大值为0.601 8,AUC为0.878。当Hcy临界值取13.55μmol/L、Cys-C临界值取1.3 mg/L时,联合诊断早期糖尿病肾病的敏感度为93.75%、特异度为88.71%,诊断指数达到最大值为0.824 6,AUC为0.957。结论联合检测Hcy及Cys-C,对诊断早期糖尿病肾病具有重要的临床价值。
Objective To investigate the clinical value of combined detection of homocysteine (Hcy) and serum cystatin C (Cys-C) in the diagnosis of early diabetic nephropathy. Methods According to the urinary albumin excretion rate (UAER), 94 patients with type 2 diabetes mellitus were divided into two groups: 62 patients in the SDM group (UAER <30 mg / 24 h); 32 patients in the early diabetic nephropathy group (EDN group) : UAER 30 mg / 24 h ~ 300 mg / 24 h. Another selection of the same period the physical examination of 40 healthy volunteers. Comparing the laboratory indicators of each group, receiver operating curve (ROC) calculated Hcy, Cys-C diagnosis of early diabetic nephropathy threshold. Results The levels of Hcy and Cys-C in EDN group were significantly higher than those in SDM group and NC group (P <0.05). When Hcy cutoff value was 13.55μmol / L, the sensitivity and specificity of diagnosing early diabetic nephropathy were 87.5%, 77.42%, 0.649 2, respectively, and the AUC was 0.872. The diagnostic sensitivity of early diabetic nephropathy was 84.38%, the specificity was 75.81%, the diagnostic index reached the maximum of 0.601 8, and the AUC was 0.878 when the critical value of Cys-C was 1.3 mg / L. When the Hcy cutoff value was 13.55μmol / L and the Cys-C cutoff value was 1.3 mg / L, the sensitivity of combined diagnosis of early diabetic nephropathy was 93.75%, the specificity was 88.71%, the diagnostic index reached the maximum of 0.824 6, and the AUC Is 0.957. Conclusion Combined detection of Hcy and Cys-C has important clinical value in the diagnosis of early diabetic nephropathy.