联合检测β2微球蛋白、同型半胱氨酸及结合中医脉象对早期糖尿病肾病的诊断价值

Clinical value of β2-MG, homocysteine and traditional Chinese medicine pulse conditions in early diagnosis of diabetic nephropathy

关键词:  糖尿病肾病  β2微球蛋白  同型半胱氨酸  中医脉象  早期诊断

Key words:  diabetic nephropathy  β2 microglobulin  homocysteine  TCM pulse conditions  early diagnosis

摘要:

[目的] 探讨检测血清β2微球蛋白(β2-MG)、同型半胱氨酸(Hcy)水平及联合中医典型脉象对糖尿病肾病(DN)的诊断价值。[方法] 连续采集2013年4月-2014年10月在天津中医药大学第二附属医院内科住院的2型糖尿病患者450例, 按尿微量白蛋白排泄率(UAER)结果分为3组, <20 μg/min为无DN组(NA,176例),20～200 μg/min为DN微量白蛋白组(MA,182例),≥200 μg/min为DN大量白蛋白尿组(LA,92例).同时检测患者β2-MG、Hcy水平, 并留取患者一般资料, 安静状态下采集患者的脉象, 采用受试者工作曲线分析各指标对DN的早期诊断价值。[结果] 3组患者中β2-MG、Hcy随尿蛋白增多逐渐升高, 其中以LA升高最为明显;3组中尺脉沉、细表现者随尿蛋白增多亦逐渐增多。两项指标及联合对DN的ROC曲线分别分析, β2-MG的曲线下面积(AUC)为0.768,Hcy的AUC为0.797,两指标联合的AUC为0.827,与脉象联合的AUC为0.866.[结论] β2-MG及Hcy均可作为DN诊断的生物学标志物, 且将两项指标进行联合检测能提高对早期DN的诊断效能, 并且联合脉象对DN评估的可信度更优。

Abstract:

[Objective] To evaluate the clinical value and specificity of serum Beta 2 microglobulin(β2-MG), homocysteine (Hcy) and traditional chinese medicine(TCM) pulse conditions in early diagnosis of diabetic nephropathy. [Methods] A prospective study was performed. Patients were consecutively collected from April 2013 to October 2014 according to the urinary albumin excretion rate(UAER) for the diagnosis of DN, and 450 patients admitted to medical ward were divided into three groups. Patients whose UAER<20 μg/min belonged to normal albuminuria(NA) group(176 cases).The ones whose UAER from 20 to 200 μg/min belonged to large albuminuria(MA) group(182 cases),and the others whose UAER ≥200 μg/min belonged to large albuminuria(LA) group(92 cases).The clinical characteristics were then compared. The concentration of serum β2-MG and Hcy in each group was measured. The general data of patients were taken. TCM pulse conditions of patients were acquired in quiet state, and then the value of each index in early diagnosis of DN was analyzed with receiver operating characteristic (ROC) curve. [Results] The serum concentration of β2-MG, Hcy exhibited a gradual increase with the aggression of the disease, and the median β2-MG, Hcy value was highest in the LA group compared with NA group and MA group;the patients with thready pulse or sunken pulse on chi pulse-taking was highest in the LA group compared with NA group and MA group. It was found through the ROC curve analysis of β2-MG, Hcy in the DN patients that the area under the ROC curve for β2-MG (0.768), for Hcy(0.797). The ROC curve analysis combined β2-MG with Hcy was better (0.827), If Combined with pulse, the ROC curve was best (0.866). [Conclusion] Serum levels of β2-MG, Hcy could be employed as biomarkers in the diagnosis and severity assessment of DN. And if the two indicators were tested at the same time, it can improve the accuracy of diagnosis of early DN, and if pulse conditions was combined , it can enhance the Credibility of diagnosis.