血清β_2微球蛋白联合N末端脑钠肽前体在2型糖尿病肾病中的临床价值研究
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摘要
目的探究血清β_2微球蛋白(β_2-microglobulin,β_2-MG)联合N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)在2型糖尿病肾病中的诊断、风险评估价值,及二者与2型糖尿病肾病病理特征的关系。方法选取2013年2月至2017年10月在我院确诊的2型糖尿病肾病患者125例为观察组,与同期在我院确诊为糖尿病并排除并发症的患者130例为对照组。比较两组研究对象血清β_2-MG与NT-proBNP水平,分析二者与2型糖尿病肾病临床病理特征的关系,受试者工作特征曲线(receiver operating characteristic,ROC)分析二者在2型糖尿病肾病中的诊断价值,Logistic回归分析二者对2型糖尿病肾病的发病风险评估价值。结果观察组血清β_2-MG与NT-proBNP水平均显著高于对照组(P<0.05),且二者水平与2型糖尿病肾病临床分期明显相关(P<0.05)。ROC曲线分析显示,联合血清β_2-MG与NT-proBNP区分2型糖尿病肾病患者和无并发症糖尿病人群的曲线下面积(area under curve,AUC)为0.974(95%CI:0.902～0.991,P<0.001),灵敏度为86.8%,特异性为94.6%。多项Logistic回归分析表明,血清高β_2-MG与NT-proBNP水平是2型糖尿病肾病发病的独立危险因素(P<0.05)。结论血清β_2-MG与NT-proBNP可协助2型糖尿病肾病的诊断,同时,二者对2型糖尿病肾病发病风险的评估也具有潜在价值。
Objective To investigate the diagnostic and risk assessment values of serum β_2-microglobulin(β_2-MG)combined with N-terminal pro-brain natriuretic peptide(NT-proBNP) in type 2 diabetic nephropathy patients and the relationships between these factors and pathological characteristics of type 2 diabetic nephropathy. Methods 125 patients with type 2 diabetic nephropathy diagnosed in our hospital from February2013 to October 2017 were selected as the observation group,and 130 patients diagnosed as type 2 diabetes but excluded complications at the same period of time in our hospital were selected as the control group. The serum levels of β_2-MG and NT-proBNP were compared between the two groups, and the relationships between these two factors and the clinicopathological features of type 2 diabetic nephropathy were analyzed.The diagnostic power was assessed by the Receiver Operating Characteristic(ROC),and the multiple logistic regression analysis was used to analyze the risk assessment value for the onset of diabetic nephropathy.Results The average levels of serum β_2-MG and NT-proBNP in the observation group were significantly higher than that of the control group(P <0. 05),and the levels of the two were significantly correlated with the clinical stage of type 2 diabetic nephropathy(P <0.05). The ROC curve showed that the area under curve(AUC)for combination of serum β_2-MG and NT-proBNP was 0. 974(95% CI:0.902-0.991,P<0.001)to distinguish patients with type 2 diabetic nephropathy from non-complication diabetes, with a sensitivity of86. 8% and a specificity of 94.6%. Logistic regression analysis showed that high levels of serum β_2-MG and NT-proBNP were independent risk factors for type 2 diabetic nephropathy( P < 0.05). Conclusion Serum β_2-MG and NT-proBNP can assist in the diagnosis of type 2 diabetic nephropathy, with the potential value for the risk assessment for type 2 diabetic nephropathy.
Objective To investigate the diagnostic and risk assessment values of serum β_2-microglobulin(β_2-MG)combined with N-terminal pro-brain natriuretic peptide(NT-proBNP) in type 2 diabetic nephropathy patients and the relationships between these factors and pathological characteristics of type 2 diabetic nephropathy. Methods 125 patients with type 2 diabetic nephropathy diagnosed in our hospital from February2013 to October 2017 were selected as the observation group,and 130 patients diagnosed as type 2 diabetes but excluded complications at the same period of time in our hospital were selected as the control group. The serum levels of β_2-MG and NT-proBNP were compared between the two groups, and the relationships between these two factors and the clinicopathological features of type 2 diabetic nephropathy were analyzed.The diagnostic power was assessed by the Receiver Operating Characteristic(ROC),and the multiple logistic regression analysis was used to analyze the risk assessment value for the onset of diabetic nephropathy.Results The average levels of serum β_2-MG and NT-proBNP in the observation group were significantly higher than that of the control group(P <0. 05),and the levels of the two were significantly correlated with the clinical stage of type 2 diabetic nephropathy(P <0.05). The ROC curve showed that the area under curve(AUC)for combination of serum β_2-MG and NT-proBNP was 0. 974(95% CI:0.902-0.991,P<0.001)to distinguish patients with type 2 diabetic nephropathy from non-complication diabetes, with a sensitivity of86. 8% and a specificity of 94.6%. Logistic regression analysis showed that high levels of serum β_2-MG and NT-proBNP were independent risk factors for type 2 diabetic nephropathy( P < 0.05). Conclusion Serum β_2-MG and NT-proBNP can assist in the diagnosis of type 2 diabetic nephropathy, with the potential value for the risk assessment for type 2 diabetic nephropathy.
引文
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[9]孙群.NT-proBNP与BMP-7水平在糖尿病肾病诊断中的临床意义[J].中国农村卫生,2016(21):42-43.
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[13]沈洁.进行血清胱抑素C和β_2-微球蛋白检测在早期诊断糖尿病肾病中的临床价值[J].当代医药论丛,2017,15(19):186-187.
[14]杨静波,李萍.糖尿病肾病患者早期实施血清β2-微球蛋白检验的影响评价[J].世界最新医学信息文摘,2017,17(101):153,161.
[15]崔学彬,邹婷,唐小铁,等.前列地尔联合胰激肽原酶治疗早期糖尿病肾病疗效及对内脂素、脂联素与β2-微球蛋白的影响[J].现代中西医结合杂志,2018,27(4):384-387.
[16]MISEK,HOSHINO J,UENO T,et al.Prognostic value of tubulointerstitial lesions,urinary N-acetyl-β-d-glucosaminidase,and urinaryβ2-microglobulin in patients with type 2 diabetes and biopsy-proven diabetic nephropathy[J].Clin J Am Soc Nephrol,2016,11(4):593-601.
[17]李莉,宋月霞,肖四海,等.糖尿病肾病患者NT-proBNP,Hcy和cTnI的水平变化及其临床意义[J].现代生物医学进展,2014,14(33):6532-6534.
[18]DANIS R1,OZMEN S,ARIKAN S,et al.Predictive value of serum NT-proBNP levels in type 2 diabetic people with diabetic nephropathy[J].Diabetes Res Clin Pract,2012,95(3):312-316.
[19]SIEBENHOFER A,NG L L,PLANK J,et al.Plasma N-terminal probrain natriuretic peptide in Type 1 diabetic patients with and without diabetic nephropathy[J].Diabet Med,2003,20(7):535-539.
[20]NIELSEN S E,SCHJOEDT K J,ROSSING K,et al.Levels of NTproBNP,markers of low-grade inflammation,and endothelial dysfunction during spironolactone treatment in patients with diabetic kidney disease[J].J Renin Angiotensin Aldosterone Syst,2013,14(2):161-166.
[2]谷君,邓文娟,左丽娟,等.2型糖尿病视网膜病变患者血清Fractalkine与血脂、血糖的相关性研究[J].中国现代医学杂志,2017,27(1):86-89.
[3]邓茹,蔡敏生.血清胱抑素C、糖化血红蛋白、hs-CRP和尿微量清蛋白联合诊断2型糖尿病患者早期肾功能损伤的价值[J].国际检验医学杂志,2017,38(3):415-417.
[4]孙钧,郑继伟,贾凡,等.2型糖尿病患者血清IL-10水平与颈动脉粥样硬化的关系[J].国际检验医学杂志,2018,39(5):548-551,554.
[5]金海英,张敏.VCAM-1、AOPP、HbAlc和FBG在二甲双胍治疗糖尿病肾病患者中的意义[J].标记免疫分析与临床,2018,25(1):50-53.
[6]陈灿锋,王家健,侯晓涛,等.2型糖尿病肾病病理分型特点与尿蛋白的关系[J].标记免疫分析与临床,2017,24(2):183-188.
[7]董闪闪,刘瑶,李奉,等.硫辛酸对糖尿病肾病Ⅲ期患者PCX和VEGF的影响[J].中国现代医学杂志,2018,28(5):77-81.
[8]陈绪林,韩骏飞,张芳琼,等.血清胱抑素C、β2-微球蛋白和尿碱性磷酸酶在糖尿病肾病诊断中的临床价值[J].中国卫生检验杂志,2017,27(7):971-972,975.
[9]孙群.NT-proBNP与BMP-7水平在糖尿病肾病诊断中的临床意义[J].中国农村卫生,2016(21):42-43.
[10]American Diabetes Association.Classification and diagnosis of diabetes:standards of medical care in diabetes-2018[J].Diabetes Care,2018,41(Suppl 1):S13-S27.
[11]NELSON R G,TUTTLE K R,BILOUS R W,et al.KDOQI clinical practice guideline for diabetes and CKD:2012 update[J].Am J Kidney Dis,2012,60(5):850-886.
[12]KHARROUBI A T,DARWISH H M.Diabetes mellitus:The epidemic of the century[J].World J Diabetes,2015,6(6):850-867.
[13]沈洁.进行血清胱抑素C和β_2-微球蛋白检测在早期诊断糖尿病肾病中的临床价值[J].当代医药论丛,2017,15(19):186-187.
[14]杨静波,李萍.糖尿病肾病患者早期实施血清β2-微球蛋白检验的影响评价[J].世界最新医学信息文摘,2017,17(101):153,161.
[15]崔学彬,邹婷,唐小铁,等.前列地尔联合胰激肽原酶治疗早期糖尿病肾病疗效及对内脂素、脂联素与β2-微球蛋白的影响[J].现代中西医结合杂志,2018,27(4):384-387.
[16]MISEK,HOSHINO J,UENO T,et al.Prognostic value of tubulointerstitial lesions,urinary N-acetyl-β-d-glucosaminidase,and urinaryβ2-microglobulin in patients with type 2 diabetes and biopsy-proven diabetic nephropathy[J].Clin J Am Soc Nephrol,2016,11(4):593-601.
[17]李莉,宋月霞,肖四海,等.糖尿病肾病患者NT-proBNP,Hcy和cTnI的水平变化及其临床意义[J].现代生物医学进展,2014,14(33):6532-6534.
[18]DANIS R1,OZMEN S,ARIKAN S,et al.Predictive value of serum NT-proBNP levels in type 2 diabetic people with diabetic nephropathy[J].Diabetes Res Clin Pract,2012,95(3):312-316.
[19]SIEBENHOFER A,NG L L,PLANK J,et al.Plasma N-terminal probrain natriuretic peptide in Type 1 diabetic patients with and without diabetic nephropathy[J].Diabet Med,2003,20(7):535-539.
[20]NIELSEN S E,SCHJOEDT K J,ROSSING K,et al.Levels of NTproBNP,markers of low-grade inflammation,and endothelial dysfunction during spironolactone treatment in patients with diabetic kidney disease[J].J Renin Angiotensin Aldosterone Syst,2013,14(2):161-166.