摘要目的 探讨血清补体组分1q(C1q)、半胱氨酸蛋白酶抑制剂C(CysC)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肌酸酐(SCr)和尿素(SUr)检测对早期糖尿病肾病(EDKD)的诊断价值.方法 回顾性研究方法.收集2017年3至11月绵阳市中心医院就诊或体检的受试者530例,其中229例糖尿病(DM组)患者被分为单纯糖尿病组(SDM组,n=100例)和EDKD组(n=129例),301名体检者作为健康对照组(HC组).测定受试者血清C1q、CysC、NGAL、SCr和SUr,评价这些指标单独检测和联合检测对EDKD的诊断性能.采用单因素方差分析比较各组间检测指标的差异,用受试者工作特征曲线评价所观察指标的诊断性能.结果 受试者血清C1q、CysC、NGAL、SCr水平(中位数),早期糖尿病肾病组分别为:187.80 mg/L、1.02 mg/L、148.70μg/L、72.00μmol/L;单纯糖尿病组分别为:177.00 mg/L、0.80 mg/L、116.20μg/L、55.35μmol/L;健康对照组:163.60 mg/L、0.75 mg/L、104.20μg/L、59.40μmol/L.早期糖尿病肾病组血清C1q、CysC、NGAL、SCr和SUr水平均显著高于单纯糖尿病组(t1值分别为6.50、9.44、3.87、9.19和4.34,P<0.05)和健康对照组(t2值分别为7.26、12.54、5.86、6.16和6.49,P<0.05).ROC曲线分析显示,单独检测时,CysC(AUC=0.837)对EDKD的诊断性能明显高于C1q(AUC=0.731)、NGAL(0.742)和SCr(AUC=0.720)(均P<0.05);两两联合检测时,C1q+CysC的诊断性能较好(AUC=0.890,Se=79.1％,Sp=86.5％,YI=0.656).在此基础上,增加检测NGAL(z=1.817,P>0.05)或NGAL+SCr(z=1.806,P>0.05)未显著改善对EDKD的诊断性能.结论 C1q、CysC和NGAL对EDKD的诊断优于SCr和SUr,其中C1q和CysC联合检测对EDKD具有更好的诊断性能.

abstractsObjective To investigate the diagnostic value of serum complement component 1 q (C1q), cystatin C (CysC), neutrophil gelatinase-associated lipocalin (NGAL), creatinine (SCr) and urea (SUr) for early diabetic kidney disease.Methods A retrospective study was conducted in 530 subjects who visited or received physical examination in Mianyang Central Hospital from March 2017 to November 2017. Of these, 229 patients with diabetes mellitus (DM group) were divided into simple diabetes mellitus group (SDM group,n=100) and early diabetic kidney disease group (EDKD group,n=129) respectively, and 301 subjects were selected as the healthy control (HC group).The levels of serum C1q, CysC, NGAL, SCr and SUr were detected in all subjects .Then, the diagnostic values of single and combined detection of these indexes for early diabetic kidney disease were evaluated .The statistical difference among the observed indexes of each group were compared by one-way ANOVA, and the diagnostic performance of those indexes were evaluated by receiver operating characteristic curve ( ROC) analysis.Results The median of serum&nbsp;C1q,CysC,NGAL and SCr in early diabetic kidney disease group were 187.80 mg/L, 1.02 mg/L, 148.70μg/L and 72.00μmol/L.The simple diabetes mellitus group were 177.00 mg/L, 0.80 mg/L, 116.20μg/L and 55.35 μmol/L.The healthy control group were 163.60 mg/L, 0.75 mg/L, 104.20μg/L and 59.40μmol/L. Compared with simple diabetes group ( t1 values were 6.50, 9.44, 3.87,9.19 and 4.34, P<0.05)and healthy control group(t2 values were 7.26, 12.54, 5.86,6.16 and 6.49, P<0.05),the levels of serum C1q, CysC, NGAL, SCr and SUr in diabetic kidney disease group were significantly increased . According to the ROC curve analysis , the diagnostic performance of CysC ( AUC=0.837 ) was much higher than those of C1q(AUC=0.731), NGAL(0.742)and SCr(AUC=0.720)for early diabetic kidney disease by using single detection.Otherwise, combined the diagnostic performance of joint detection reached the better when combined C1q and CysC (AUC =0.890,Se =79.1％, Sp =86.5％, YI =0.656).While increase detection of NGAL (z=1.817, P>0.05) or NGAL+SCr (z=1.806,P>0.05) did not further improve the diagnosis performance of early diabetic kidney disease .Conclusions C1q, CysC and NGAL with equal diagnostic performances are superior to SCr and SUr in diagnosis of early diabetic kidney disease . Among them, the combined detection of C1q and CysC has better diagnostic performance for early diabetic kidney disease.