尿微量蛋白、胱抑素C、糖化血紅蛋白及晚期糖基化終末產物對糖尿病早期腎損傷的應用評價

朱曉英+施笑婭+徐象威

[摘要] 目的 探討尿微量白蛋白（UmALB）、胱抑素C（Cys-C）、糖化血紅蛋白（HbA1c）及晚期糖基化終末產物（AGEs）四項指標對糖尿病早期腎功能損傷的臨床價值。 方法 選擇2015年12月～2016年12月符合標準的糖尿病患者120例，分為正常白蛋白尿組（NAU）37 例、微量白蛋白尿組（MIAU）44例和大量白蛋白尿組（MAAU）39例。選擇同期30例健康體檢人群為對照組（HC），比較各組UmALB、Cys-C、HbA1c、AGEs濃度水平及陽性率，并行方法學指標評價。 結果 ①四組患者一般資料無統計學差異（P>0.05）。②四組患者UmALB、Cys-C、HbA1c、AGEs濃度水平均有統計學差異（P<0.01）。其中NAU組HbA1c、AGEs水平明顯高于HC組（P<0.01）；MIAU組UmALB、Cys-C、AGEs水平明顯高于NAU組（P<0.01）；MAAU組四項指標均明顯高于NAU組（P<0.01），且與MIAU組比較，UmALB、Cys-C、AGEs結果有統計學差異（P<0.01）。③各組檢測方法陽性率有統計學差異（P<0.01）。其中MIAU組與MAAU組的陽性率明顯高于HC組與NAU組（P<0.01）。方法學評價上AGEs最高，其次為Cys-C、UmALB、HbA1c。 結論 UmALB、Cys-C、HbA1c、AGEs對糖尿病早期腎功能損傷具有重要的診斷價值，其中AGEs、Cys-C檢測準確度更為可靠，值得臨床進一步推廣。

[關鍵詞] 糖尿病腎病；晚期糖基化終末產物；血清胱抑素C；尿微量蛋白；糖化血紅蛋白

[中圖分類號] R446.12；R587.2；R692.9 [文獻標識碼] B [文章編號] 1673-9701（2017）33-0116-05

[Abstract] Objective To investigate the application value of four indices of urinary microalbumin（UmALB）， cystatin C（Cys-C）， glycosylated hemoglobin（HbA1c） and advanced glycation end products（AGEs） on early diabetic kidney injury. Methods 120 patients with diabetes who were in accordance with the standard from December 2015 to December 2016 were selected. Among them， there were 37 patients in the normal albuminuria group（NAU）， 44 patients in the microalbuminuria group（MIAU） and 39 patients in the macroalbuminuria group（MAAU）. 30 healthy people were selected as the control group（HC） during the same period of time. The concentration levels of UmALB， Cys-C， HbA1c， AGEs and the positive rate were compared between groups， and evaluation of methodological indicators was carried out. Results ①There was no statistically significant difference in general data between the four groups（P>0.05）. ②The concentration levels of UmALB， Cys-C， HbA1c and AGEs in the four groups were statistically different（P<0.01）. The levels of HbA1c and AGEs in NAU group were significantly higher than those in HC group（P<0.01）； the levels of UmALB， Cys-C and AGEs in MIAU group were significantly higher than those in NAU group（P<0.01）； the four indices in the MAAU group were significantly higher than those in the NAU group（P<0.01）. Compared with MIAU group， the results of UmALB， Cys-C and AGEs were statistically different（P<0.01）. ③The positive rate of test methods in each group was statistically different（P<0.01）. The positive rate in MIAU group and MAAU group was significantly higher than that in HC group and NAU group（P<0.01）. In methodological evaluation， the highest was AGEs， followed by Cys-C， UmALB， and HbA1c. Conclusion UmALB， Cys-C， HbA1c and AGEs have important diagnostic value in early diabetic kidney injury， in which the test accuracy of AGEs and Cys-C is more reliable， which is worthy of further clinical promotion.endprint