标题：血清Hcy、CysC、RBP及尿足细胞联合检测对2型糖尿病肾病早期诊断的临床价值

      作者：徐晏玲 1，艾禾 2，漆丹平 3    1.成都市双流区中医医院内科，四川 成都 610200；2.成都市中西医结合医院科教部，四川 成都 610041；3.成都市双流区中医医院检验科，四川 成都 610200

      卷次： 2021年32卷22期

      【摘要】 目的 探究血清同型半胱氨酸(Hcy)、胱抑素C (Cys C)、视黄醇结合蛋白(RBP)及尿足细胞联合检测对2型糖尿病肾病早期诊断的临床价值。方法 选择成都市双流区中医医院2019年1月至2020年8月间收治的58例2型糖尿病肾病早期患者作为A组，同时选取我院收治的58例单纯糖尿病患者作为B组，同时期在我院体检的健康者58例作为C组。检测并比较三组受检者的血清Hcy、CysC、RBP及尿足细胞水平，并采用受试者工作特征(ROC)曲线评价Hcy、CysC、RBP、尿足细胞单一检测和联合检测诊断的敏感性。结果 A组患者的血清Hcy、CysC、RBP、尿足细胞水平分别为(21.2±3.5) μmol/L、(1.8±0.3) mg/L、(3.1±0.7) mg/L、(2.8±0.8)个/μL，均明显高于B组[(19.7±2.8) μmol/L、(1.5±0.2) mg/L、(2.6±0.5) mg/L、(2.3±0.6)个/μL] 及C组[(11.7±1.9) μmol/L、(0.7±0.1) mg/L、(0.8±0.1) mg/L、(0.7±0.1)个/μL]，且B组患者的血清Hcy、CysC、RBP、尿足细胞水平明显高于C组，差异均具有统计学意义(P<0.05)；将A组和B组进行研究，以肾小球滤过率<90 mL/min作为2型糖尿病肾病诊断切点，ROC分析结果显示，血清Hcy、CysC、RBP及尿足细胞诊断最佳切点分别为20.81 μmol/L、1.75 mg/L、2.91 mg/L以及2.73个/μL，各项指标检测结果显示，Hcy、CysC、RBP和尿足细胞检测的诊断敏感性分别为58.2%、80.8%、79.3%、和62.5%、四者联合检测的诊断敏感性为91.7%。结论 2型糖尿病患者在出现肾损伤时，血清Hcy、CysC、RBP及尿足细胞水平明显升高，四者联合检测有助于提高2型糖尿病肾病患者早期诊断敏感性，值得推广应用。
      【关键词】 2型糖尿病肾病；同型半胱氨酸；胱抑素C；视黄醇结合蛋白；尿足细胞；诊断价值
      【中图分类号】 R587.2 【文献标识码】 A 【文章编号】 1003—6350（2021）22—2907—03

Clinical value of combined detection of serum Hcy, CysC, RBP, and uropodocytes for early diagnosis of type 2diabetic nephropathy.
XU Yan-ling 1, AI He 2, QI Dan-ping 3. 1. Department of Internal Medicine, Chengdu ShuangliuHospital of Traditional Chinese Medicine, Chengdu 610200, Sichuan, CHINA; 2. Ministry of Science and Education,Chengdu Integrated TCM&Western Medicine Hospital, Chengdu 610041, Sichuan, CHINA; 3. Department of ClinicalLaboratory, Chengdu Shuangliu Hospital of Traditional Chinese Medicine, Chengdu 610200, Sichuan, CHINA
【Abstract】 Objective To explore the clinical value of combined detection of serum homocysteine (Hcy), cys-tatin C (Cys C), retinol binding protein (RBP), and uropodocytes for early diagnosis of type 2 diabetic nephropathy.Methods Fifty-eight patients with type 2 diabetic nephropathy admitted to Chengdu Shuangliu Hospital of TraditionalChinese Medicine from January 2019 to August 2020 were selected as group A, 58 patients with simple diabetes were se-lected as group B, and 58 healthy persons who were undergoing physical examination in the hospital during the same timewere selected as group C. The serum levels of Hcy, CysC, RBP, and uropodocytes were detected and compared in the threegroups, and receiver operating characteristic (ROC) curve was used to evaluate the sensitivity of single and combined de-tection of Hcy, CysC, RBP and uropodocytes. Results The serum levels of Hcy, CysC, RBP, and uropodocytes in groupA were significantly higher than those in group B and group C, i.e. Hcy (21.2±3.5) μmol/L vs (19.7±2.8) μmol/L and (11.7±1.9) μmol/L, CysC (1.8±0.3) mg/L vs (1.5±0.2) mg/L and (0.7±0.1) mg/L, RBP (3.1±0.7) mg/L vs (2.6±0.5) mg/L and (0.8±0.1) mg/L, uropodocytes (2.8±0.8) pcs/μL vs (2.3±0.6) pcs/μL and (0.7±0.1) pcs/μL, and the levels of Hcy, CysC, RBPand uropodocytes in group B were significantly higher than those in group C; all differences were statistically significant(P<0.05). Comparing group A and group B and using glomerular filtration rate <90 mL/min as the diagnosis cut-offpoint for type 2 diabetic nephropathy, ROC analysis showed that the best cut-off points for the diagnosis with serumHcy, CysC, RBP, and uropodocytes was respectively 20.81 μmol/L, 1.75 mg/L, 2.91 mg/L, and 2.73 cells/μL. The singlediagnostic sensitivity of Hcy, CysC, RBP, and uropodocytes was 58.2%, 80.8%, 79.3%, and 62.5%, respectively, and thecombined detection of the four had a diagnostic sensitivity of 91.7% . Conclusion The serum levels of Hcy, CysC,RBP, and uropodocytes in type 2 diabetic patients with renal injury are significantly increased. The combined detectionof the four can help improve the sensitivity of early diagnosis of type 2 diabetic nephropathy, which is worthy of popular-ization and application.
      【Key words】 Type 2 diabetic nephropathy; Homocysteine; Cystatin C; Retinol binding protein; Uropodocytes;Diagnostic value