目的 探讨血清β2 微球蛋白(β2-MG)、胱抑素C(Cys C)及血清淀粉样蛋白A(SAA)与Ⅱ型糖尿病肾病病理特征的关系.方法 选取2013年6月至2017年12月山西大医院肾内科收治的250例Ⅱ型糖尿病患者,根据尿微量白蛋白排泄率检查结果将患者分为Ⅱ型糖尿病肾病组与无并发症糖尿病组.比较两组患者血清β2-MG、Cys C及SAA水平,分析三者与Ⅱ型糖尿病肾病临床病理特征的关系,受试者工作特征曲线( ROC)分析三者在Ⅱ型糖尿病肾病中的诊断价值,多元logistic回归分析三者对Ⅱ型糖尿病肾病的发病风险评估价值.结果 Ⅱ型糖尿病肾病组患者的血清β2-MG[(2.5 ± 0.3)mg/L]、Cys C[(7.1 ± 1.4)mg/L]及SAA[(32.4 ± 2.8) mg/L]水平均高于无并发症糖尿病组患者[(1.5 ± 0.1)mg/L、(0.9 ± 0.2)mg/L、(6.4 ± 1.2) mg/L],差异有统计学意义(P<0.05),且三者水平与Ⅱ型糖尿病肾病临床分期明显相关,差异有统计学意义(P<0.05). ROC曲线分析显示,联合血清β2-MG、Cys C和SAA区分Ⅱ型糖尿病肾病患者和无并发症糖尿病人群的曲线下面积( AUC)为 0.974 (95% CI:0.902 ~0.991, P <0.001 ),灵敏度为 86.8% ,特异度为94.6% .多项logistic回归分析表明,血清β2-MG、Cys C和SAA水平是Ⅱ型糖尿病肾病发病的独立危险因素,差异有统计学意义(P<0.05).结论 血清β2-MG、Cys C和SAA可协助Ⅱ型糖尿病肾病的诊断,同时三者对Ⅱ型糖尿病肾病发病风险的评估也具有潜在价值.
Objective To investigate serum β2 microglobulin(β2-MG),cystatin C(Cys C)and se-rum amyloid A(SAA) relationship with the typeⅡdiabetic nephropathy. Methods A retrospective study was performed on 250 cases of patients with type Ⅱ diabetic nephropathy who were admitted from June 2013 to December 2017. According to the result of urine trace albumin excretion rate test divided the pa-tients into Ⅱ diabetes nephropathy group and the group with uncomplications of diabetes. Compared two groups of patients'serum β2-MG,Cys C and SAA levels,and analysis of three Ⅱ type,the relationship be-tween clinical features of diabetic nephropathy in the receiver-operating characteristic curve(ROC)analysis three Ⅱ type of the diagnostic value of diabetic nephropathy,multivariate logistic regression analysis of the three type of Ⅱ diabetic nephropathy risk assessment of the value. Results Ⅱ diabetes nephropathy pa-tients with serum β2-MG [(2.5 ±0.3) mg/L],Cys C [(7.1 ± 1.4) mg/L] and SAA [(32.4 ± 2.8) mg/L] levels were higher than in patients with uncomplicated diabetes group [( 1.5 ± 0.1 ) mg/L, ( 0.9 ± 0.2)mg/L and(6.4 ± 1.2)mg/L],and the difference was statistically significant(P<0.05);the three sig-nificantly related with Ⅱ diabetes kidney disease clinical stage,and the difference was statistically signifi- cant(P<0.05). ROC curve analysis showed that the combined β2-MG,serum Cys C and SAA distinguishⅡ diabetes nephropathy patients and no complications from diabetes area under curve( AUC) was 0.974 (95% CI:0.902 to 0.991,P<0.001),the sensitivity was 86.8% ,94.6% . Multiple logistic regression a-nalysis showed that the β2-MG,serum Cys C and SAA levels is the pathogenesis of diabetic nephropathyⅡtype independent risk factors(P<0.05). Conclusion Serum β2-MG,serum Cys C and SAA can assist in the diagnosis of diabetic nephropathy Ⅱ type,at the same time,the three Ⅱ diabetes nephropathy risk as-sessment also has potential value.