HbA1c、C肽和尿NAG对2型糖尿病早期肾损伤的诊断价值

doi:10.3969/j.issn.1673-8640.2017.011.020

摘要/Abstract

摘要：

目的探讨糖化血红蛋白（HbA_1c）、血清C肽和尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）单项及联合检测对2型糖尿病（T2DM）早期肾损伤的诊断价值。方法选取236例T2DM患者及62名体检健康者（正常对照组）,根据尿微量白蛋白/肌酐比值（ACR）将T2DM患者分为T2DM早期肾损伤组（124例）和单纯T2DM组（112例）。分别检测3个组HbA_1c、血清C肽及尿NAG。采用受试者工作特征（ROC）曲线评价各项指标的诊断价值。结果正常对照组、单纯T2DM组和T2DM早期肾损伤组HbA_1c、尿NAG水平依次增高,血清C肽水平则依次降低,各组间差异均有统计学意义（P<0.05）。HbA_1c、血清C肽和尿NAG 联合检测诊断T2DM早期肾损伤的ROC曲线下面积（AUC）为0.936,明显高于各项指标单项检测（AUC分别为0.860、0.883、0.709）及两两联合检测（HbA_1c+尿NAG、HbA_1c+血清C肽和尿NAG+血清C肽的AUC分别为0.876、0.919、0.902）;3项指标联合检测的敏感性和特异性分别为91.9%和85.7%。结论 HbA_1c、血清C肽和尿NAG是判断T2DM早期肾损伤的有效指标,3项指标联合检测有助于提高T2DM早期肾损伤的检出率。

关键词: 糖化血红蛋白, C肽, N-乙酰-β-D-氨基葡萄糖苷酶, 2型糖尿病, 糖尿病肾病

Abstract:

Objective To investigate the roles of glycated hemoglobin A_1c（HbA_1c）,serum C-peptide and urinary N-acetyl-beta-D-glucosaminidase（NAG） determinations for the diagnosis of early renal damage in type 2 diabetes mellitus（T2DM）. Methods A total of 236 T2DM patients and 62 healthy subjects（healthy control group） were enrolled. According to urinary albumin to creatinine ratio（ACR）,the T2DM patients were classified into T2DM with early renal damage group（124 cases） and simple T2DM group（112 cases）. The levels of HbA_1c,serum C-peptide and urinary NAG in the 3 groups were determined. Receiver operating characteristic（ROC） curve was used to assess the diagnostic efficiency of each index. Results The levels of HbA_1c and urinary NAG in healthy control group,simple T2DM group and T2DM with early renal damage group were increased in turn,and the levels of serum C-peptide was decreased in turn（P<0.05）. The area under ROC curve（AUC） of the combined determination of HbA_1c,serum C-peptide and urinary NAG for the diagnosis of early renal damage in T2DM was 0.936,which was higher than those of individual determinations（AUC were 0.860,0.883 and 0.709）and two-index combined determinations（AUC were 0.876 for HbA_1c+urinary NAG,0.919 for HbA_1c+serum C-peptide and 0.902 for urinary NAG+serum C-peptide）. The sensitivity and specificity of the combined determination of 3 indices were 91.9% and 85.7%,respectively. Conclusions HbA_1c,serum C-peptide and urinary NAG are sensitive for the diagnosis of early renal damage in T2DM,and the combined determination of 3 indices may improve the determination rate of early renal damage.

Key words: Glycated hemoglobin A1c, C-peptide, N-acetyl-beta-D-glucosaminidase, Type 2 diabetes mellitus, Diabetic nephropathy

中图分类号:

R446.1

孟凡飞, 刘萍, 杨聚豪, 蒲晓允. HbA_1c、C肽和尿NAG对2型糖尿病早期肾损伤的诊断价值[J]. 检验医学, 2017, 32(11): 1031-1035.

MENG Fanfei, LIU Ping, YANG Juhao, PU Xiaoyun. Glycated hemoglobin A_1c,C-peptide and urinary N-acetyl-beta-D-glucosaminidase determinations for the diagnosis of early renal damage in type 2 diabetes mellitus[J]. Laboratory Medicine, 2017, 32(11): 1031-1035.

图/表 5

参考文献 11

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组别	例数	糖尿病病程（年）	血糖（mmol/L）	尿ACR（mg/mmol）
T2DM早期肾损伤组	124	8.9±1.6^*	10.5±1.9^*	25.86±3.11^*
单纯T2DM组	112	3.8±0.9^*﹟	8.3±1.2^*﹟	8.19±0.92^*﹟
正常对照组	62		5.3±0.6	4.13±0.41

组别	例数	糖尿病病程（年）	血糖（mmol/L）	尿ACR（mg/mmol）
T2DM早期肾损伤组	124	8.9±1.6^*	10.5±1.9^*	25.86±3.11^*
单纯T2DM组	112	3.8±0.9^*﹟	8.3±1.2^*﹟	8.19±0.92^*﹟
正常对照组	62		5.3±0.6	4.13±0.41

组别	例数	C肽（ng/mL）	NAG（U/L）	HbA_1c（%）
T2DM早期肾损伤组	124	0.46±0.15^*	18.65±2.15^*	8.6±1.4^*
单纯T2DM组	112	1.83±0.46^*﹟	13.48±1.37^*﹟	7.7±1.1^*﹟
正常对照组	62	2.11±0.37	4.95±0.76	5.3±0.5
F值		56.017	62.324	49.567
P值		0.000	0.000	0.000

组别	例数	C肽（ng/mL）	NAG（U/L）	HbA_1c（%）
T2DM早期肾损伤组	124	0.46±0.15^*	18.65±2.15^*	8.6±1.4^*
单纯T2DM组	112	1.83±0.46^*﹟	13.48±1.37^*﹟	7.7±1.1^*﹟
正常对照组	62	2.11±0.37	4.95±0.76	5.3±0.5
F值		56.017	62.324	49.567
P值		0.000	0.000	0.000

因素	B值	标准误	Wald值	P值	OR值（95%CI）
HbA_1c	0.524	0.132	9.237	0.000	1.572（1.076~1.894）
NAG	0.439	0.094	9.168	0.087	3.176（1.102~1.557）
C肽	0.731	0.598	5.379	0.000	1.589（1.033~1.645）