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中华临床实验室管理电子杂志

中华临床实验室管理电子杂志 ›› 2021, Vol. 09 ›› Issue (01) : 19 -23. doi: 10.3877/cma.j.issn.2095-5820.2021.01.004

所属专题： 文献；

实验研究

血清SOD、NGAL及KIM-1水平对2型糖尿病早期肾损伤的诊断价值
刘桂荣1, 黎灵锋1,†(), 韦慧萍1, 胡世杰1, 温应方1   
  1. 1. 514000　广东梅州，中山大学附属第三医院粤东医院检验科
  • 收稿日期:2020-09-14 出版日期:2021-02-28
  • 通信作者: 黎灵锋
  • 基金资助:
    梅州市科技计划项目(181227212051403)

The diagnostic value of serum SOD, NGAL and KIM-1 levels in early kidney injury of type-2 diabetes

Guirong Liu1, Lingfeng Li1,†(), Huiping Wei1, Shijie Hu1, Yingfang Wen1   

  1. 1. Department of Laboratory, The 3rd Affiliated Hospital of Sun Yat-Sen University Yuedong Hospital, Meizhou Guangdong 514000, China
  • Received:2020-09-14 Published:2021-02-28
  • Corresponding author: Lingfeng Li
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刘桂荣, 黎灵锋, 韦慧萍, 胡世杰, 温应方. 血清SOD、NGAL及KIM-1水平对2型糖尿病早期肾损伤的诊断价值[J]. 中华临床实验室管理电子杂志, 2021, 09(01): 19-23.

Guirong Liu, Lingfeng Li, Huiping Wei, Shijie Hu, Yingfang Wen. The diagnostic value of serum SOD, NGAL and KIM-1 levels in early kidney injury of type-2 diabetes[J]. Chinese Journal of Clinical Laboratory Management(Electronic Edition), 2021, 09(01): 19-23.

目的

测定2型糖尿病患者血清超氧化物歧化酶(SOD)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)及肾损伤分子-1(KIM-1)水平，并分析其诊断价值。

方法

选取2型糖尿病患者212例，根据尿微量白蛋白/尿肌酐比值(ACR)分为阴性组(n=163)和阳性组(n=49)，另选择同期进行体检的健康人118例作为对照组，测定血清SOD、NGAL及KIM-1水平，并进行统计学分析，计算SOD、NGAL及KIM-1单独或联合对糖尿病早期肾损伤的诊断价值。

结果

阴性组SOD水平显著低于对照组［218(176~234)］ U/mL vs ［233(192~276)］ U/mL， P＜0.001，阳性组SOD水平显著低于阴性组［172(142~215)］ U/mL vs ［218(176~234)］ U/mL， P＜0.01；阴性组NGAL水平与对照组相比差异无统计学意义［46.2(22.3~68.1)］ mg/L vs ［39.4(19.8~47.3)］ mg/L，P＞0.05，阳性组NGAL水平显著高于阴性组［98.6(56.4~130.0)］ mg/L vs ［46.2(22.3~68.1)］ mg/L，P＜0.001；阴性组KIM-1水平高于对照组［43.0(35.9~51.4)］ ng/L vs ［33.2(28.1~37.9)］ ng/L，P＜0.05，阳性组KIM-1水平高于阴性组［77.6(54.2~93.8)］ ng/L vs ［43.0(35.9~51.4)］ ng/L，P＜0.001。SOD、NGAL及KIM-1对糖尿病早期肾损伤的检出率百分比为73.47%、85.71%和87.76%，ROC曲线下面积分别为0.737、0.816和0.876；三者并联应用后，阳性检出率为95.92%，联合应用的ROC曲线下面积为0.957。

结论

糖尿病早期肾损伤伴随血清SOD水平的降低和NGAL、KIM-1水平的上升，三者联合检测有助于糖尿病早期肾损伤的检出和及早干预。

关键词: 2型糖尿病, 糖尿病肾病, 超氧化物歧化酶, 中性粒细胞明胶酶相关脂质运载蛋白, 肾损伤分子-1

Obejctive　To determine the level of serum superoxide dismutase (SOD), neutrophil gelatinase-related lipocalin (NGAL) and Kindney Injury Molecule 1 (KIM-1)in patients with type 2 diabetes, and to analyze its diagnostic value.

Methods

A total of 212 patients with type 2 diabetes were selected and divided into a negative group (n = 163) and a positive group (n = 49) according to urine microalbumin / urine creatinine ratio (ACR), and 118 healthy people who underwent health examinations at the same time were selected as health control. Serum SOD, NGAL and KIM-1 levels were measured, and statistical analysis was performed to calculate the diagnostic value of SOD and NGAL alone or in combination for early renal injury in diabetes.

Results

The SOD level in the negative group was significantly higher than that in control group [218(176~234)] U/mL vs [233(192~276)] U/mL, P＜0.001, and the SOD level in the positive group was signally lower than that in the negative group [172(142~215)] U/mL vs [218(176~234)] U/mL, P＜0.01; There was no significant difference in the NGAL level between the negative group and control group [46.2(22.3~68.1)] mg/L vs [39.4(19.8~47.3)] mg/L, P＞0.05, The NGAL level in the positive group was notably lower than that in the negative group [98.6(56.4~130.0)] mg/L vs [46.2(22.3~68.1)] mg/L, P＜0.001; the KIM-1 level in the negative group was markedly higher than that in the control group [43.0(35.9~51.4)] ng/L vs [33.2(28.1~37.9)] ng/L, P＜0.05, the KIM-1 level in the positive group was prominently lower than that in the negative group [77.6(54.2~93.8)] ng/L vs [43.0(35.9~51.4)] ng/L, P＜0.001. The detection rate of SOD, NGAL and KIM-1 for early diabetic kidney injury was 73.47%, 85.71% and 87.76% respectively, and the area under the ROC curve was 0.737, 0.816 and 0.876, respectively. The positive detection rate was 95.92% after the three were applied in combination, where the area under the ROC curve is 0.957.

Conclusion

With the decrease of serum SOD level and the increase of NGAL and KIM-1 level, the combined detection of these three levels is helpful for the detection and early intervention of renal injury in early diabetic stage.

Key words: Type-2 Diabetes mellitus, Diabetic Nephropathy, Superoxide Dismutase, Neutrophil gelatinase-associated lipocalin
表1 各组间基本信息比较
组别 例数(例) 年龄(岁) 性别(男/女)
阴性组 163 59.24±8.33 79/84
阳性组 49 60.67±9.12 26/23
对照组 118 59.05±8.92 57/51
P值 0.426 0.581
表2 3组研究对象血清SOD、NGAL及KIM-1检测结果比较
组别 n SOD(U/mL) NGAL(mg/L) KIM-1(ng/mL)
阴性组 163 218(176~234)** 46.2(22.3~68.1) 43.0(35.9~51.4)*
阳性组 49 172(142~215)** # 98.6(56.4~130.0)** ## 77.6(54.2~93.8)**##
对照组 118 233(192~276) 39.4(19.8~47.3) 33.2(28.1~37.9)
图1 各诊断指标的ROC曲线
表3 SOD、NGAL和KIM对糖尿病肾损伤的预测分析(%)
检测指标 敏感度 特异性 总符合率 假阳性率 假阴性率
MAU 83.67(41/49) 64.42(105/163) 68.87(146/212) 35.58(58/163) 16.33(8/49)
SOD 73.47(36/49) 66.87(109/163) 68.40(145/212) 33.13(54/163) 26.53(13/49)
NGAL 85.71(42/49) 86.50(141/163) 86.32(183/212) 13.50(22/163) 14.29(7/49)
KIM-1 87.76(43/49) 83.44(136/163) 84.43(179/212) 16.56(27/163) 12.24(6/49)
SOD+NGAL 89.80(44/49) 87.12(142/163) 87.74(186/212) 12.88(21/163) 10.20(5/49)
SOD+KIM-1 91.84(45/49) 88.96(145/163) 89.62(190/212) 11.04(18/163) 9.86(4/49)
NGAL+KIM-1 91.84(45/49) 93.87(153/163) 93.40(198/212) 6.13(10/163) 8.16(4/49)
三指标联合 95.92(47/49) 94.48(154/163) 94.81(201/212) 5.52(9/163) 4.08(2/49)
表4 KIM、SOD及NGAL单独或联合应用对糖尿病肾损伤的诊断效能
检测指标 Cut-Off值 AUC 95%置信区间 P
SOD 200.5 0.737 0.657~0.818 ＜0.001
NGAL 73.5 0.816 0.728~0.904 ＜0.001
KIM-1 38.3 0.876 0.803~0.948 ＜0.001
NGAL+KIM-1 — 0.929 0.817~0.987 ＜0.001
三指标联合 — 0.957 0.803~0.948 ＜0.001
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