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投稿时间：2019-10-31 网络发布日期：2020-06-20
投稿时间：2019-10-31 网络发布日期：2020-06-20
中文摘要: 目的 探究尿微量白蛋白/肌酐比值(ACR)、糖化血红蛋白(HbAlc)、超敏C反应蛋白(hs-CRP)联合检测在早期糖尿病肾病中的诊断价值,并建立个体化预测糖尿病肾病风险的列线图模型。方法 选择华北理工大学附属医院内分泌科2018年1月至2019年8月收治的101例T2DM(2型糖尿病)患者,其中54例为单纯2型糖尿病组,47例为伴糖尿病肾病的2型糖尿病组,50例健康体检者为对照组,3组人群均进行ACR、HbAlc、hs-CRP检测,评估其单独和联合诊断效能。应用R软件进行DN风险预测的列线图模型建立,采用Bootstrap法进行验证。结果 糖尿病肾病组ACR、HbAlc、hs-CRP水平均高于单纯2型糖尿病组患者,差异均具有统计学意义(P<0.05);3项指标联合诊断的灵敏度和特异度分别为87.2%和87.0%,均高于各指标单独检测效能。列线图预测DN风险的一致性指数C-index为0.922,区分度良好;校准图显示预测风险发生率与实际风险发生率有着良好的一致性,ROC曲线下面积（AUC）为0.943。结论 将ACR、HbAlc、hs-CRP联合用于早期糖尿病肾病的诊断中应用价值较高,且本研究基于这三项诊断指标所建立的个体化预测DN发生风险的列线图模型具有良好的准确度与区分度,对于2型糖尿病DN高风险人群的早期诊断和干预提供了可靠的依据。
Abstract:Objecitve To explore the diagnostic value of combined detection of urine microalbumin/creatinine ratio (ACR), glycosylated hemoglobin (HbAlc) and high-sensitivity C-reactive protein (hs-CRP) in early diabetic nephropathy (DN) and to establish the individualized nomogram model for predicting the risk of DN. Methods Out of 101 patients with type 2 diabetes mellitus(T2DM) treated in Affiliated Hospital of North China University of Science and Technology from January 2018 to August 2019, there were 54 patients with simple T2DM (T2DM group) and 47 T2DM patients with diabetic nephropathy (DN group).In the same period, 50 healthy people were served as control group.ACR, HbAlc and hs-CRP detections alone or in combination were performed to evaluate their diagnostic performance in three groups.The nomogram prediction model of risk factors for DN was established by R software and verified using the bootstrap method. Results The levels of ACR, HbAlc and hs-CRP in DN group were significantly higher than those in T2DM group (P<0.05).The sensitivity and specificity of three indexes joint test were 87.2% and 87.0% and were respectively higher than individual test performance of the indicators.The consistency index of the nomogram predicting DN risk was 0.922, with a good degree of cellular differentiation.The calibration chart showed a good consistency between the predicted risk incidence and the actual risk incidence.The area under the ROC curve of combined detection for diagnosing DN was 0.943. Conclusion The combined detection of ACR, HbAlc and hs-CRP is of high value in the diagnosis of early diabetic nephropathy, and the nomogram model based on these three indicators has good accuracy and degree of differentiation, which provides a reliable basis for the early diagnosis and intervention of high-risk population with type 2 diabetic DN.
keywords: Urinary albumin/creatinine ratio Glycosylated hemoglobin High-sensitivity C-reactive protein Diabetic nephropathy Early diagnosis Nomogram
文章编号： 中图分类号： 文献标志码：B
基金项目:河北省卫计委科技成果推广课题(20150523)
引用文本：
杨春伟,王晓涛,赵永魁,等.早期糖尿病肾病3项指标联合个体化诊断模型的建立[J].中国临床研究,2020,33(6):781-783,787.
杨春伟,王晓涛,赵永魁,等.早期糖尿病肾病3项指标联合个体化诊断模型的建立[J].中国临床研究,2020,33(6):781-783,787.