尿肾功能放射免疫检测在糖尿病肾病早期诊断中的应用价值分析

    The value of radioimmunoassay for urinary renal function in evaluation of the development of diabetic kidney disease in type 2 diabetes

    • 摘要: 目的 评估肾小球损伤指标尿微量白蛋白(microalbumin,mAlb)与尿免疫球蛋白G (immunoglobulin,IgG)和肾小管损伤指标尿β2微球蛋白(β2-microglobulin,β2-MG)和尿α1微球蛋白(α1-microglobulin,α1-MG)在糖尿病肾脏病(diabetic kidney disease,DKD)损伤时的应用价值。方法 回顾性分析2017年6月至2019年3月于西京医院核医学科进行肾功能放射免疫分析的2型糖尿病患者154例及健康志愿者77名。根据估算肾小球滤过率(estimate glomerular filtration rate,eGFR)将糖尿病患者分为轻度损伤组、中度损伤组、重度损伤组。对不同组别患者的临床资料、肾功能指标进行分析比较,并采用受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)对各指标在糖尿病肾病诊断时应用价值进行评价。结果 肾功能轻度损伤组尿mAlb与尿IgG即出现增高(与对照组比较,尿mAlb中位数:1.78 μg/mL比1.14 μg/mL,P=0.022;尿IgG中位数:1.44 μg/mL比0.84 μg/mL,P=0.038)。胱抑素C (cystatin C,CysC)、尿β2-MG及尿α1-MG在中度损伤组出现升高(与对照组比较:PCysC=0.029,P尿β2-MG<0.001,P尿α1-MG<0.001)。ROC曲线对DKD诊断进行评估,曲线下面积(area under the curve,AUC)显示:肾小球指标中尿mAlb (AUC=0.800)与尿IgG (AUC=0.802),肾小管指标尿α1-MG (AUC=0.791)具有用于DKD早期诊断的预测价值。结论 肾功能损伤指标在DKD损伤出现的时期有所不同,尿mAlb及尿IgG在肾功早期损伤时即出现升高,肾小管相关指标在出现中度损伤时才出现升高,其中尿α1-MG较尿β2-MG更适合于肾功能的评价。因此,建议在肾功能评价时全面选择肾小球与肾小管指标,对肾功能进行综合判断。

       

      Abstract: Objective To evaluate the value of glomerular protein markers(albumin & IgG) and tubular protein markers(β2-MG & α1-MG) in evaluating the development of diabetic kidney disease(DKD) in type 2 diabetics. Methods A total of 154 type 2 diabetics and 77 non-diabetic controls were recruited and divided into 3 groups of mild,moderate and severe impairment according to the level of estimated glomerular filtration rate(eGFR). Clinical parameters,markers of kidney damage and receiver operating characteristic curve(ROC) curve were employed for analyzing the values of diagnosing DKD. Results As compared with controls,albumin and IgG rose during mild impairment(a median of albumin 1.78 μg/mL vs 1.14 μg/mL,P=0.022,a median of IgG 1.44 μg/mL vs 0.84 μg/Ml,P=0.038). CysC,β2-MG and α1-MG became elevated during moderate impairment(versus control PCysC=0.029,Pβ2-MG<0.001,Pα1-MG<0.001). ROC curve indicated that albumin(AUC=0.800),IgG(AUC=0.802) and α1-MG(AUC=0.791) were more effective in diagnosing DKD. Conclusion Different markers of kidney damage are elevated during different stages. For DKD,both albumin and IgG are effective for making an early diagnosis. And α1-MG is more suitable for evaluating tubular damage. So,while evaluating the damage of kidney,both glomerular and tubular protein markers should be adopted.

       

    /

    返回文章
    返回