| Objective(s):To explore the diagnostic value of combined detection of alpha 1 microglobulin(al-MG),urinary microalbumin(U-mAlb),urinary transferrin(UTf)and urinary immunoglobulin G(IgU)for early renal injury in type 2 diabetes mellitus.Methods:A total of 85 patients with type 2 diabetes mellitus(T2DM)hospitalized in our hospital from October 2017 to December 2018 were selected.According to the classification criteria of American kidney foundation(K/DOQI)in 2001,they were divided into 3 groups:group A(normal renal function group,41 patients with eGFR>90ml·min-1·1.73m-2);Group B(mild renal function injury group,60 ml·min-1·1.73m-2<eGFR<90ml·min-1·1.73m-2)27 cases;Group C(moderate to severe renal function injury group,eGFR<60 ml-min-1·1.73m-2)had 17 cases.Thirty healthy subjects who came to our hospital for physical examination during the same period were selected as the normal control group.To collect all the object of study of gender,age,body mass index(BMI)and other relevant materials,the research object of cholesterol(TC),triglycerides(TG),high-density lipoprotein(HDL-C),low density lipoprotein(LDL-C),fasting plasma glucose(FPG),glycosylated hemoglobin(HbAlc),Serum urea nitrogen(UREA),serum creatinine(SCr),alpha 1 microglobulin(a1-MG),urine trace albumin(U-mAlb),urinary transferrin(UTf),urine immunoglobulin G(IgU),and other indicators,To investigate the variation characteristics of al-MG,U-mAlb,UTf and IgU in different degrees of renal injury and the correlation with eGFR.The diagnostic value of single test and four combined tests for early renal injury in type 2 diabetes mellitus was compared by analyzing the characteristic working curve(ROC).Results:There were no statistically significant differences in gender,age,BMI,systolic blood pressure,diastolic blood pressure,TC,TG,HDL-C,and LDL-C between groups A,B,and C and the control group(P>0.05).The levels of FPG and HbAlc in group A,B and C were significantly higher than those in the control group(P<0.05),but there was no significant difference between groups(P>0.05).Compared with the control group,the levels of al-MG,U-mAlb,UTf and IgU in groups A,B and C began to increase when the renal function was normal in the early stage,and gradually increased with the aggravation of renal function injury,the difference was statistically significant(P<0.05).However,UREA and SCr levels showed no significant changes when compared with the control group when renal function was normal,and the differences were statistically significant when renal function was slightly impaired and when it was moderate to severe(P<0.05),and increased with the aggravation of renal injury.There was a good negative correlation between al-MG,U-mAlb,UTf,IgU and eGFR,and the difference was statistically significant(P<0.05).The correlation coefficient and P value were(r=-0.586,P<0.001,respectively;r=-0.538,P<0.001;r=-0.629,P=<0.001;r=-0.702,P<0.001).ROC curves showed that the AUC under a1-MG,U-mAlb,UTf,IgU and the four combined tests were 0.776,0.830,0.727,0.796 and 0.852,respectively.The AUC(0.852)of the four combined tests was the highest,higher than that of each individual test.Conclusion(s):1.al-MG,U-mAlb,UTf and IgU combined detection can greatly improve the detection sensitivity,and the combined detection efficiency is better than the single detection,which is of great significance for monitoring the occurrence and progression of early renal injury in T2DM.2.al-MG,U-mAlb,UTf and IgU can all be used as sensitive indicators to reflect early renal injury,and their sensitivity is,in turn,al-MG,U-mAlb,U-mAlb,IgU and UTf.The sensitivity of al-mg is better than that of U-mAlb in the traditional diagnosis of early renal injury in T2DM.3.Negative correlation between al-MG,U-mAlb,U-mAlb,IgU and eGFR can reflect the change of eGFR.IgU and eGFR have a good correlation.4.al-MG(small molecule protein)in the early days as the specificity of the renal tubular damage indexes in patients with T2DM,U-mAlb,UTf(proteins)in the early glomerular damage in patients with T2DM,IgU(macromolecular protein)in the urine concentration increased significantly,can prompt a significant increase in the glomerular filtration membrane aperture glomerular filtration membrane is damaged seriously,we more wary.Dynamic and multi-angle monitoring can reflect the progression of renal injury. |
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