摘要
目的研究D-二聚体(D-D)对2型糖尿病(T2DM)患者早期肾脏疾病风险评估的临床应用价值。方法选取内分泌病房305例2型糖尿病患者作为研究对象,根据预估肾小球滤过率(eGFR)分为三组,分别为组I:eGFR≥90ml/(min·1.73m^-2);组II:eGFR:60~89ml/(min·1.73m^-2)和组III:eGFR 30~59m/(min·1.73m^-2),检测D-D,纤维蛋白原(FIB),胱抑素C(Cys-C)和尿清蛋白/肌酐比值(ACR)等指标;再以D-D的75%分位数分组为DD≤0.46mg/L和D-D>0.46mg/L,对两组患者检测指标进行单因素分析;以eGFR<60ml/(min·1.73m^-2)作为肾损伤判定标准,进行D-D,FIB和Cys-C对肾损伤风险Logistic回归及诊断指标的分析。结果组I,II和III之间两两比较:得到组III中DD,Cys-C和FIB分别与组II和组I比较,差异均有统计学意义(F=0.26,P<0.01,F=0.34,P<0.01;F=0.60,P<0.01,F=0.90,P<0.01;F=0.92,P<0.01,F=0.92,P<0.01),得到组II中DD和Cys-C与组I差异有统计学意义(F=0.08,P<0.01,F=0.3,P<0.01);DD分组进行比较:D-D>0.46mg/L组患者的尿ACR,FIB,Cys-C和eGFR阳性率均高于D-D≤0.46mg/L组,差异有统计学意义(χ2=16.50,47.74,69.11,89.91,均P<0.01);Logistic回归分析:DD,FIB和Cys-C水平升高发生肾功能损伤的风险高于正常水平,差异有统计学意义[Exp(B)=6.07,P<0.01,Exp(B)=3.76,P<0.01,Exp(B)=53.34 P<0.01],三指标联合检测的诊断试验的ROC曲线下面积是0.943。结论血浆D-二聚体水平与2型糖尿病患者早期肾损伤的发生存在相关性。D-二聚体,FIB和Cys-C水平与2型糖尿病患者肾脏疾病的进展相关,并且三者联合检测对肾脏疾病风险的预测具有临床意义。
Objective To study the clinical value of serum D-dimer(D-D)in the risk assessment of early renal disease in patients with type 2 diabetes(T2DM).Methods 305 patients with T2DM in the endocrine ward were selected as research objects.According to the predicted glomerular filtration rate(eGFR),they were divided into three groups:group I:eGFR≥90ml/(min·1.73m^-2),group II:eGFR:60~89ml/(min·1.73m^-2),group III:eGFR 30~59ml/(min·1.73m^-2).The D-dimer(D-D),fibronogen(FIB),cystine C(Cys-C)and ratio of urinary albumin/cteatinine(ACR)were detected.Then,according to the 75%quartile of DD,they were grouped into D-D≤0.46mg/L and D-D>0.46 mg/L,and univariate analysis was carried out on the detection indexes of the two groups.The risk of renal injury was analyzed by using eGFR<60 ml/(min·1.73m^-2)as the criterion of renal injury.D-D,FIB and Cys-C analysis of risk Logistic regression and diagnostic indexes of kidney injury。Results Compared with D-D,Cys-C and FIB between group I,II and III:there were significant difference in group III between group II and group I(F=0.26,P<0.01,F=0.34,P<0.01;F=0.60,P<0.01,F=0.90,P<0.01;F=0.92,P<0.01,F=0.92,P<0.01).Compared with D-D and Cys-C between group I and II,there were significant difference between group II and group I(F=0.08,P<0.01,F=0.3,P<0.01).Comparison D-D groups:the positive rates of urine ACR,FIB,Cys-C and eGFR in DD>0.46 mg/L group were higher than those in DD≤0.46 mg/L group(χ2=16.50,47.74,69.11,89.91,all P<0.01).Logistic regression:the risk of increasing the level of D-D,FIB and Cys-C was 6.07,3.76,53.34,all P<0.01 with statistically significant differences,respectively,and the area under the ROC curve of the three-index combined test was 0.943.Conclusion Serum D-dimer levels were associated with early renal injury in patients with type 2 diabetic,and suggests that D-dimer,FIB and Cys-C levels were associated with the progression of kidney disease in patients with type 2 diabetes.The combined detection of the three has clinical significance in predicting the risk of ki
作者
刘倩倩
鲁作华
王星
韩书光
赵晓静
汤沛
刘兴晖
LIU Qian-qian;LU Zuo-hua;WANG Xing;HAN Shu-guang;ZHAO Xiao-jing;TANG Pei;LIU Xing-hui(Department of Clinical Laboratory,Gongli Hospital of Pudong New Area in Shanghai,Shanghai 200135,China)
出处
《现代检验医学杂志》
CAS
2020年第4期134-138,共5页
Journal of Modern Laboratory Medicine
基金
浦东新区卫生系统重点学科群建设资助(PWZxq2017-15)
浦东新区卫生系统领先人才培养计划(PWRI2018-05)。
