血清NGAL、Cys C和尿NAG联合检测在糖尿病肾病诊断中的临床意义

doi:10.3969/j.issn.1673-8640.2015.11.009

摘要/Abstract

摘要： 目的

探讨血清中性粒细胞明胶酶相关载脂蛋白(NGAL)、半胱氨酸蛋白酶抑制剂C(Cys C)和尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)检测在糖尿病肾病(DN)诊断中的临床意义。

方法

选取2型糖尿病患者(T2DM)76例,根据其尿液白蛋白排泄率(UAER)分成3组:正常白蛋白尿组(26例,UAER<30 mg/24 h)、微量白蛋白尿组(25例,UAER为30~300 mg/24 h)、临床蛋白尿组(25例,UAER>300 mg/24 h);选择同期正常体检者40名作为正常对照组。检测所有对象的血清NGAL、Cys C和尿NAG,分析检测结果与肾小球滤过率(GFR)的关系,采用受试者工作特征(ROC)曲线下面积评价3个指标对DN的诊断效率。

结果

微量白蛋白尿组和临床蛋白尿组血清NGAL、Cys C和尿NAG水平均高于正常对照组(P<0.05);T2DM患者血清NGAL、Cys C和尿NAG水平与GFR呈负相关[相关系数(r)分别为-0.855 23、-0.760 14、-0.701 17,P均<0.05];3项指标中血清NGAL的ROC曲线下面积(0.862)最高,诊断效率最好。

结论

血清NGAL与GFR关系最为密切,可用于DN的早期诊断和监测。

Abstract: Objective

To investigate the clinical significance of serum neutrophil gelatinase-associated lipocalin(NGAL), cystatin C(Cys C) and urinary N-acetyl-beta-D-glucosaminidase(NAG) in the diagnosis of diabetic nephropathy (DN).

Methods

According to urinary albumin excretion rate(UAER),76 type 2 diabetes mellitus(T2DM) patients were classified into 3 groups, normal albuminuria group(26 cases, UAER<30 mg/24 h), micro-albuminuria group(25 cases, UAER=30-300 mg/24 h) and clinical albuminuria group(25 cases, UAER>300 mg/24 h). Another 40 healthy subjects were enrolled as healthy control group. The relationship of NGAL, Cys C and urinary NAG with glomerular filtration rate (GFR) was analyzed. The area under receiver operating characteristic (ROC) curve was used for the diagnosis efficiency of DN .

Results

Serum NGAL,Cys C and urinary NAG of micro-albuminuria group and clinical albuminuria group were higher than those of healthy control group(P<0.05). Serum NGAL ,Cys C and urinary NAG were negatively correlated with GFR [correlation coefficient(r)=-0.855 23, -0.760 14 and -0.701 17, P<0.05]. The area under ROC curve of serum NGAL (0.862) was biggest, and the diagnosis efficiency was highest.

Conclusions

Serum NGAL which has a good correlation with GFR is expected to be used in clinical diagnosis and monitor.

Key words: Neutrophil gelatinase-associated lipocalin, Cystatin C, N-acetyl-beta-D-glucosaminidase, Diabetic nephropathy

中图分类号:

R446.1

王依屹, 张珏, 鲁传翠, 罗云桃. 血清NGAL、Cys C和尿NAG联合检测在糖尿病肾病诊断中的临床意义[J]. 检验医学, 2015, 30(11): 1096-1099.

WANG Yiyi, ZHANG Jue, LU Chuancui, LUO Yuntao. Clinical significance on serum NGAL,Cys C and urinary NAG combined determination in the diagnosis of diabetic nephropathy[J]. Laboratory Medicine, 2015, 30(11): 1096-1099.

图/表 3

参考文献 16

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组别	例数	UAER (mg/24 h)	NGAL (mg/L)	Cys C (mg/L)	NAG (U/L)	GFR [mL/(min·1.73 m²)]
正常对照组	40	6.25±1.85	144.05±58.62	0.87±0.19	6.82±2.02	106.78±4.98
正常白蛋白尿组	26	6.99±1.65	221.69±36.91^*	1.29±0.16^*	8.17±1.80	113.39±6.75
微量白蛋白尿组	25	53.75±25.95^*#	301.65±42.07^*#	1.64±0.24^*#	13.33±2.63^*#	90.15±9.34^*#
临床蛋白尿组	25	462.23±236.29^*#△	517.81±130.67^*#△	5.54±2.01^*#△	19.13±8.31^*#△	70.19±11.24^*#△

组别	例数	UAER (mg/24 h)	NGAL (mg/L)	Cys C (mg/L)	NAG (U/L)	GFR [mL/(min·1.73 m²)]
正常对照组	40	6.25±1.85	144.05±58.62	0.87±0.19	6.82±2.02	106.78±4.98
正常白蛋白尿组	26	6.99±1.65	221.69±36.91^*	1.29±0.16^*	8.17±1.80	113.39±6.75
微量白蛋白尿组	25	53.75±25.95^*#	301.65±42.07^*#	1.64±0.24^*#	13.33±2.63^*#	90.15±9.34^*#
临床蛋白尿组	25	462.23±236.29^*#△	517.81±130.67^*#△	5.54±2.01^*#△	19.13±8.31^*#△	70.19±11.24^*#△

项目	ROC曲线下面积	标准误	P值	渐近95%可信区间
项目	ROC曲线下面积	标准误	P值	下限	上限
NGAL	0.862	0.045	<0.001	0.773	0.950
Cys C	0.836	0.047	<0.001	0.745	0.928
NAG	0.805	0.057	<0.001	0.693	0.916

项目	ROC曲线下面积	标准误	P值	渐近95%可信区间
项目	ROC曲线下面积	标准误	P值	下限	上限
NGAL	0.862	0.045	<0.001	0.773	0.950
Cys C	0.836	0.047	<0.001	0.745	0.928
NAG	0.805	0.057	<0.001	0.693	0.916