目的：探讨血清胱抑素 C（CysC）、糖化血红蛋白（HbA1c）、同型半胱氨酸（Hcy）及尿微量白蛋白（U-mAlb）联合检测对早期糖尿病肾病（DN）患者的诊断价值。方法检测252例 DN 的住院患者（观察组）和160例健康体检者（对照组）血清 CysC、Hcy、HbA1c 和 U-mAlb 水平。观察 CysC、Hcy、HbA1c 和 U-mAlb 联合检测对 T2DM合并 DN 患者诊断的敏感性和特异性。结果在血清 CysC、Hcy、HbA1c 和 U-mAlb 单项检测中，对 DN 患者的敏感性由高到低依次为 HbA1c（84．1％）、Hcy（75．4％）、U-mAlb（63．5％）和 CysC（60．3％）。观察组血清 CysC、Hcy、HbA1c 和 U-mAlb 水平均明显高于对照组（均 P ＜0．01）。血清 CysC、Hcy、HbA1c 和 U-mAlb 联合检测时，诊断敏感性高达96．8％。结论血清 CysC、Hcy、HbA1c 和 U-mAlb 均可作为早期 DN 的诊断指标，联合检测意义更大。%ABSTRACT:Objective To investigate the value of combined detection of serum cystatin C(Cy-sC),homocysteine(Hcy),microalbuminuria(U-mAlb)and glycated hemoglobin(HbA1c)in the diagnosis of early diabetic nephropathy(DN).Methods The levels of serum CysC,Hcy,HbA1c and U-mAlb were detected in 252 inpatients with type 2 diabetes mellitus(T2DM)complicated by DN(observation group)and 160 healthy subjects(control group).The sensitivity and specificity of combined detection were analyzed.Results The sensitivity of HbA1c,Hcy,U-mAlb and CysC for diagnosis of DN was 84.1%,75.4%,63.5% and 60.3%,respectively.Compared with control group,serum levels of CysC,Hcy,HbA1c and U-mAlb significantly increased in observation group(P <0.01).The sensitivity of combined detection of HbA1c,Hcy,U-mAlb and CysC for di-agnosis of DN was 96.8%.Conclusion Serum CysC,Hcy,HbA1c and U-mAlb can be used as the diagnostic markers of early DN,and combined detection of these markers has higher sensitivity than individual detection.
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