血清NGAL水平对2型糖尿病肾脏疾病的筛查价值
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摘要
目的:评价血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平在筛查糖尿病肾脏疾病(DKD)中的应用价值。方法:收集单纯2型糖尿病(T2DM)患者877例和DKD患者492例,并按疾病分层将其分为训练集914例(T2DM患者573例,DKD患者341例)和验证集455例(T2DM患者304例,DKD患者151例)。训练集用以建立各指标与DKD的联合检测模式;验证集用以比较分析单独/联合检测模式对DKD的筛查性能及其与临床诊断的一致性。结果:DKD患者血清Urea、Cr、CysC、NGAL和尿液ACR水平均高于T2DM患者,而eGFR低于T2DM患者(P <0. 001)。eGFR、ACR和NGAL与DKD有关联(OR=1. 077、1. 031和1. 007,P <0. 001)。由此建立单独或联合检测模式中,ACR/eGFR/NGAL联合检测的性能及其与临床诊断的一致性均高于其他筛查模式(AUC=0. 960,Kappa=0. 805,P <0. 001)。结论:血清NGAL检测可能是DKD筛查的有效补充,在ACR和eGFR基础上联合检测NGAL,可避免DKD漏诊。
Aim: To evaluate the diagnostic values of serum neutrophil gelatinase-associated lipocalin(NGAL) in screening diabetic kidney disease(DKD). Methods: A total of 877 patients with type 2 diabetes(T2DM) and 492 patients with DKD were consecutively collected,who were allocated into the training group of 914 cases(including 573 cases of T2DM and 341 cases of DKD) and the validation group of 455 cases(including 304 cases of T2DM and 151 cases of DKD),according to stratified random sampling by disease. The training group was used to analyze the relation of DKD with serum Urea,Cr,Cys C,e GFR,NGAL,Glu and urinary ACR,and establish some combined detection modes with the closely related indices. The validation group was used to compare and analyze the performance for screening DKD by alone or combined detection modes,and the consistency of various modes with clinical diagnosis. Results: Serum Urea,Cr,Cys C,NGAL and urinary ACR levels of the patients with DKD were significantly higher,but e GFR level was significantly lower compared with the patient with T2DM(P < 0. 001). Out of these indices,only e GFR,ACR and NGAL were closely associated with DKD(OR = 1. 077,1. 031,1. 007,P < 0. 001). Among the alone or combined detection modes establish by the three indices,ACR/e GFR/NGAL mode had better performance and higher consistency with clinical diagnosis than other screening modes(AUC = 0. 960,Kappa = 0. 805,P < 0. 001). Conclusion: Serum NGAL detecting may be an effective supplement for DKD screening,and joint detection of ACR,e GFR and NGAL could avoid the missed diagnosis of DKD.
Aim: To evaluate the diagnostic values of serum neutrophil gelatinase-associated lipocalin(NGAL) in screening diabetic kidney disease(DKD). Methods: A total of 877 patients with type 2 diabetes(T2DM) and 492 patients with DKD were consecutively collected,who were allocated into the training group of 914 cases(including 573 cases of T2DM and 341 cases of DKD) and the validation group of 455 cases(including 304 cases of T2DM and 151 cases of DKD),according to stratified random sampling by disease. The training group was used to analyze the relation of DKD with serum Urea,Cr,Cys C,e GFR,NGAL,Glu and urinary ACR,and establish some combined detection modes with the closely related indices. The validation group was used to compare and analyze the performance for screening DKD by alone or combined detection modes,and the consistency of various modes with clinical diagnosis. Results: Serum Urea,Cr,Cys C,NGAL and urinary ACR levels of the patients with DKD were significantly higher,but e GFR level was significantly lower compared with the patient with T2DM(P < 0. 001). Out of these indices,only e GFR,ACR and NGAL were closely associated with DKD(OR = 1. 077,1. 031,1. 007,P < 0. 001). Among the alone or combined detection modes establish by the three indices,ACR/e GFR/NGAL mode had better performance and higher consistency with clinical diagnosis than other screening modes(AUC = 0. 960,Kappa = 0. 805,P < 0. 001). Conclusion: Serum NGAL detecting may be an effective supplement for DKD screening,and joint detection of ACR,e GFR and NGAL could avoid the missed diagnosis of DKD.
引文
[1]UMANATH K,LEWIS JB.Update on diabetic nephropathy:core curriculum 2018[J].Am J Kidney Dis,2018,71(6):884
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[5]FENG JF,QIU L,ZHANG L,et al.Multicenter study of creatinine-and/or cystatin C-based equations for estimation of glomerular filtration rates in Chinese patients with chronic kidney disease[J].PLo S One,2013,8(3):e57240
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[8]BORONAT M,GARCIA-CANTON C,QUEVEDO VA,et al.Non-albuminuric renal disease among subjects with advanced stages of chronic kidney failure related to type 2 diabetes mellitus[J].Ren Fail,2014,36(2):166
[9]LEE E,OH HJ,PARK JT,et al.The incidence of cardiovascular events is comparable between normoalbuminuric and albuminuric diabetic patients with chronic kidney disease[J].Medicine(Baltimore),2016,95(15):e3175
[10]GOHDA T,NISHIZAKI Y,MURAKOSHI M,et al.Clinical predictive biomarkers for normoalbuminuric diabetic kidney disease[J].Diabetes Res Clin Pract,2018,141:62
[11]LACQUANITI A,DONATO V,PINTAUDI B,et al."Normoalbuminuric"diabetic nephropathy:tubular damage and NGAL[J].Acta Diabetol,2013,50(6):935
[2]TOTH-MANIKOWSKI S,ATTA MG.Diabetic kidney disease:pathophysiology and therapeutic targets[J].J Diabetes Res,2015,2015:697010
[3]CHEN C,WANG C,HU C,et al.Normoalbuminuric diabetic kidney disease[J].Front Med,2017,11(3):310
[4]DE CARVALHO JA,TATSCH E,HAUSEN BS,et al.Urinary kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin as indicators of tubular damage in normoalbuminuric patients with type 2 diabetes[J].Clin Biochem,2016,49(3):232
[5]FENG JF,QIU L,ZHANG L,et al.Multicenter study of creatinine-and/or cystatin C-based equations for estimation of glomerular filtration rates in Chinese patients with chronic kidney disease[J].PLo S One,2013,8(3):e57240
[6]SHIMIZU M,FURUICHI K,TOYAMA T,et al.Long-term outcomes of Japanese type 2 diabetic patients with biopsyproven diabetic nephropathy[J].Diabetes Care,2013,36(11):3655
[7]EKINCI EI,JERUMS G,SKENE A,et al.Renal structure in normoalbuminuric and albuminuric patients with type 2diabetes and impaired renal function[J].Diabetes Care,2013,36(11):3620
[8]BORONAT M,GARCIA-CANTON C,QUEVEDO VA,et al.Non-albuminuric renal disease among subjects with advanced stages of chronic kidney failure related to type 2 diabetes mellitus[J].Ren Fail,2014,36(2):166
[9]LEE E,OH HJ,PARK JT,et al.The incidence of cardiovascular events is comparable between normoalbuminuric and albuminuric diabetic patients with chronic kidney disease[J].Medicine(Baltimore),2016,95(15):e3175
[10]GOHDA T,NISHIZAKI Y,MURAKOSHI M,et al.Clinical predictive biomarkers for normoalbuminuric diabetic kidney disease[J].Diabetes Res Clin Pract,2018,141:62
[11]LACQUANITI A,DONATO V,PINTAUDI B,et al."Normoalbuminuric"diabetic nephropathy:tubular damage and NGAL[J].Acta Diabetol,2013,50(6):935