标题：两种方法检测超敏C反应蛋白诊断2型糖尿病患者颈动脉内中膜厚度的价值

      作者：李娟红 1，赵子贤 2，曾凤群 1，利雯秀 1，陈世豪 1，叶青云 1，李敬红 3
    (南方医科大学附属新会医院检验科 1、输血科 2、内分泌科 3，广东 江门 529100)

      卷次： 2016年27卷16期

      【摘要】 目的 探讨两种方法检测超敏C反应蛋白(hs-CRP)对 2型糖尿病(T2DM)患者颈动脉内中膜厚度
（IMT）增加的诊断价值。方法 选择2013年4月至2015年4月我院收治的84例T2DM患者，以彩色多普勒超声诊
断仪检查患者颈动脉的结果为标准，按 IMT<0.9 mm和 IMT≥0.9 mm分成颈动脉正常组 40例和颈动脉增厚组 44
例。同期另选42例健康查体者为正常对照组，分别采用乳胶增强免疫散射比浊法和颗粒增强免疫透射比浊法检测
所有受检者的全血 hs-CRP和血清 hs-CRP的水平，用受试者工作特征(ROC)曲线评价两种方法检测 hs-CRP对
T2DM患者 IMT增加的诊断效能。另用总胆固醇(TC)联合全血hs-CRP检测评价对T2DM患者 IMT增加的诊断效
能。结果 两种方法显示 IMT增厚组的全血[(4.78±1.04) mg/L]和血清hs-CRP水平[(4.43±0.95) mg/L]均高于 IMT
正常组[(1.85±0.78) mg/L和(1.70±0.89) mg/L]和正常对照组[(0.98±0.67) mg/L和(0.87±0.59) mg/L]，差异均有统计学
意义(P<0.05)。用ROC曲线分析得全血 hs-CRP的诊断灵敏度(76.2%)较高，而特异性(47.1%)较低，曲线下面积为
0.612，而颗粒增强免疫透射比浊法检测血清hs-CRP的诊断灵敏度(69.0%)较低，特异性(52.9%)较高，曲线下面积为
0.596；全血hs-CRP联合总胆固醇(TC)诊断的灵敏度(83.3%)和特异性(64.7%)，曲线下面积为0.732，均高于hs-CRP
单项指标诊断效能。结论 T2DM患者 IMT增加时，血液中 hs-CRP水平升高；乳胶增强免疫散射比浊法检测
hs-CRP对T2DM患者 IMT增加的诊断效能优于颗粒增强免疫透射比浊法；全血 hs-CRP联合TC检测能提高对
T2DM患者 IMT增加的诊断灵敏度和特异性。

      【关键词】 乳胶增强免疫散射比浊法；颗粒增强免疫透射比浊法；2型糖尿病；超敏C反应蛋白；颈动脉内中膜
厚度；总胆固醇；诊断

      【中图分类号】 R587.1 【文献标识码】 A 【文章编号】 1003—6350（2016）16—2615—04


Diagnostic value of hs-CRP detected by two assays in determining carotid intima-media thickness of patients
with type 2 diabetes mellitus.
LI Juan-hong 1, ZHAO Zi-xian 2, ZENG Feng-qun 1, LI Wen-xiu 1, CHEN Shi-hao 1, YE
Qing-yun 1, LI Jing-hong 3. Department of Laboratory 1, Department of Blood Transfusion 2, Department of Endocrinology 3,
Xinhui Hospital Afiliated to Southern Medical University, Jiangmen 529100, Guangdong, CHINA

【Abstract】 Objective To evaluate the value of hypersensitive C-reaction protein (hs-CRP) detected by two assays
in diagnosing increased carotid intima-media thickness (IMT) of patients with type 2 diabetes mellitus. Methods With the
findings of cervical vascular color Doppler ultrasound examination as standard, 84 patients with T2DM, who admitted to
our hospital from April 2013 to April 2015, were chosen and divided into the normal IMT group (n=40, IMT<0.9 mm) and
the IMT increased group (n=44, IMT≥0.9 mm) according to the IMT level. At the same time, 42 healthy people were cho-
sen as the control group. The whole blood and serum concentration of hs-CRP in the patients of normal IMT group, IMT
increased group and control group were detected by latex-enhanced immunonephelometry method and partied-enhanced
turbidimetric immunoassay respectively. The application value of the two assays in the diagnosis of patients of type 2 dia-
betes mellitus with increased carotid intima-media thickness was evaluated by the receiver operating characteristic (ROC)
curve. In addition, the total cholesterol combined with hs-CRP were detected to evaluate the application value of the diag-
nosis of patients of type 2 diabetes mellitus with increased carotid intima-media thickness. Results The two assays
showed that the level of hs-CRP in whole blood and serum of IMT increased group [(4.78±1.04) mg/L, (4.43±0.95) mg/L,
respectively] were significantly higher than those of the normal IMT group [(1.85±0.78) mg/L, (1.70±0.89) mg/L, respec-
tively] and the healthy control [(0.98±0.67) mg/L and (0.87±0.59) mg/L] (P<0.05). The ROC curve analysis showed that
the latex-enhanced immunonephelometry method had higher sensitivity (76.2%) and lower specificity (47.1%), with the
areas under ROC curve for 0.612; the partied-enhanced turbidmetric method had lower sensitivity (69.0%) and higher
specificity (52.9% ), with the areas under ROC curve for 0.596. Compared to the single index test, the sensitivity of
hs-CRP and total cholesterol combination detection had higher sensitivity (83.3%) and higher specificity (64.7%), with
the areas under ROC curve for 0.732. Conclusion The blood hs-CRP level rises with the increase of IMT in the pa-
tients with T2DM. The latex-enhanced immunonephelometry method is better than the partied-enhanced turbidimetric
immunoassay method in the diagnostic performance of increased carotid int